Sex‐ and age‐related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long‐Term Registry

Abstract

AimsThis study aimed to assess age-and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients.Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P ≤ 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P = 0.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P < 0.001) and there were no differences in causes of death. All-cause mortality and all-cause hospitalization increased with greater age in both sexes. Sex was not an independent predictor of 1-year all-cause mortality (restricted to patients with LVEF ≤45%). Mortality risk was significantly lower in patients of younger age, compared to patients aged >75 years.

Sex Differences in Comorbidity, Therapy, and Health Services’ Use of Heart Failure in Spain: Evidence from Real-World Data

“…However, women have been historically included in a smaller proportion (around 30%) than men in clinical trials, and their therapeutic management and prognosis have been less studied. All this leads to a lower prescription in women of the treatments recommended by clinical practice guidelines [12,31,[40][41][42] and, for reasons not entirely clear, with lower average drug doses [9,[43][44][45]. Although information on drug doses used and on the LVEF of our patients were not available in our cohort, we confirmed, in general, the lower prescription of the specific treatments for HF in women.…”

“…Conde-Martel et al, among others, observed similar diuretics consumption in both sexes [23,26], whereas in other studies, greater use has been reported in men, despite women presenting with greater congestion [15,26,40]. The higher prevalence of ischemic heart disease and arrhythmias in men would justify the greater dispensation of anti-coagulation and anti-aggregation treatments, in line with the results of Dewan et al [26], who also found a greater use of statins [6,41]. In other studies, greater side-effects related to ACE inhibitors have been reported for women, such as cough or angioedema [5,43,46,47].…”

“…Males consumed more drugs for cardiovascular events than women did, which could be justified by the greater frequency of ischemic heart disease in men [6,41]. The greater combined use of ACE inhibitors/ARB, beta-blockers, and antialdosteronics could be justified by a higher prevalence of reduced LVEF in men [41]. In any case, the low use of ACE inhibitors/ARB and BB, which have been shown to improve the prognosis of the disease, as well as the high consumption of diuretics in clinically stable patients, is striking.…”

Sodium–glucose co‐transporter 2 inhibitors in heart failure: beyond glycaemic control. A position paper of the Heart Failure Association of the European Society of Cardiology

“…19 Furthermore, dapagliflozin appears safe and effective in vulnerable elderly patients, as well as in those with impaired renal function (excluding patients with estimated glomerular filtration rate <30 mL/min/1.73 m 2 ), in whom up-titration of GDMT may be challenging. 68,69 A post-hoc analysis of the DAPA-HF trial demonstrated similar risk reductions in HF hospitalisation and mortality with dapagliflozin, irrespective of background HF therapy, including ACEi/ARB, beta-blockers, MRAs, ivabradine, sacubitril/valsartan, cardiac resynchronisation therapy and implantable cardioverter-defibrillators. 70 Furthermore, the results were consistent regardless of whether patients received ≥50% or <50% of guideline-directed target doses of ACEi/ARBs, beta-blockers, or MRAs.…”

January 2020 at a glance: translational medicine, predictors of outcome and treatments

“…Ageing is an established major determinant of adequacy and adherence to treatment and of survival in patients with HF. [8][9][10][11] Lainščak et al 12 evaluated age-and sex-related differences in HF management, mortality and hospitalization in the patients enrolled in the ESC HFA EORP HF Long-Term registry. Age >75 years was associated with underutilization of optimal medical therapy and with increased mortality.…”