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

the European Society of Cardiology Heart Failure Long-Term Registry Investigators Group

doi:10.1002/ejhf.1645

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

the European Society of Cardiology Heart Failure Long-Term Registry Investigators Group

Bar-Ilan University - Azrieli Faculty of Medicine

Research output: Contribution to journal › Article › peer-review

94 Scopus citations

Abstract

Aims: This 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. Methods and results: 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. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF ≤45%.

Original language	English
Pages (from-to)	92-102
Number of pages	11
Journal	European Journal of Heart Failure
Volume	22
Issue number	1
DOIs	https://doi.org/10.1002/ejhf.1645
State	Published - 1 Jan 2020

Bibliographical note

Publisher Copyright:
© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology

Funding

Since its initiation, the EURObservational Research Programme has been supported by Abbott Vascular International (2011?2021), Amgen Cardiovascular (2009?2018), AstraZeneca (2014?2021), Bayer AG (2009?2018), Boehringer Ingelheim (2009?2019), Boston Scientific (2009?2012), the Bristol-Myers Squibb and Pfizer Alliance (2011?2019), Daiichi Sankyo Europe GmbH (2011?2020), the Daiichi Sankyo Europe GmbH and Eli Lilly & Company Alliance (2014?2017), Edwards (2016?2019), Gedeon Richter (2014?2016), Menarini International Operations (2009?2012), MSD-Merck & Co. (2011?2014), Novartis Pharma AG (2014?2020), ResMed (2014?2016), Sanofi (2009?2011), Servier (2009?2021) and Vifor (2019?2022). Conflicts of interest: M.G.C.-L. reports the receipt of personal fees from Novartis, Abbott, MSD and Astellas, and grants from CIBERCV outside the submitted work. L.H.L. reports the receipt of personal fees from Merck, Sanofi, AstraZeneca, Bayer, Pharmacosmos and Abbott Medscape, grants and personal fees from Boehringer Ingelheim, Vifor-Fresenius, Relypsa, Novartis and Mundipharma, and grants from Boston Scientific outside the submitted work. S.D.A. reports the receipt of personal fees from Bayer, BI, Servier, Novartis and Respicardia, grants and personal fees from Vifor, and grants from Abbott Vascular outside the submitted work. R.F. reports the receipt of grants and personal fees from Servier International and Novartis, and personal fees from Merck Serono, Bayer and Boehringer Ingelheim outside the submitted work. A.J.S.C. reports the receipt of personal fees from AstraZeneca, Menarini, Novartis, Nutricia, Respicardia, Servier, Stealth Peptides, Vifor, Actimed, Faraday and WL Gore outside the submitted work. G.F. reports having served on the committees of trials and registries sponsored by Bayer, Novartis, Servier, Vifor, Medtronic and BI outside the submitted work. A.P.M. reports the receipt of personal fees from Bayer, Fresenius and Novartis outside the submitted work. Prior to 2018, F.R. reports the receipt of grants and personal fees from SJM/Abbott, Servier, Novartis and Bayer, and personal fees from Zoll, AstraZeneca, Sanofi, Amgen, BMS, Pfizer, Fresenius, Vifor, Roche, Cardiorentis and Boehringer Ingelheim, other funding from Heartware, and grants from Mars outside the submitted work; since 1 January 2018 F.R. has received no personal payments and all payments have been made to the University of Zurich. M.B.Y. reports the receipt of grants from Novartis, Amgen and Bayer during the conduct of the study. P.M.S. reports the receipt of grants and other research support from the Ministry of Education, Science and Technological Development of the Republic of Serbia, the receipt of honoraria or consultation fees from Servier, Boehringer Ingelheim, Hemofarm, Novartis and AstraZeneca, and has participated in a company-sponsored speakers' bureau for Fondazione Internationale Menarini. M.L., I.M., M.P., T.M., M.F.P., G.M.C.R., D.S., M.A, J.-C.E. and C.L. have nothing to disclose. The input of the EURObservational Research Programme (EORP) Oversight Committee, and Registry Executive and Steering Committees is acknowledged. Data collection was conducted by the EORP department of the European Society of Cardiology by Emanuela Fiorucci as project officer, and G?rard Gracia and Maryna Andarala as data managers. Statistical analyses were performed by C?cile Laroche. Overall activities were coordinated and supervised by A.P.M. (EORP Scientific Coordinator). Since its initiation, the EURObservational Research Programme has been supported by Abbott Vascular International (2011?2021), Amgen Cardiovascular (2009?2018), AstraZeneca (2014?2021), Bayer AG (2009?2018), Boehringer Ingelheim (2009?2019), Boston Scientific (2009?2012), the Bristol-Myers Squibb and Pfizer Alliance (2011?2019), Daiichi Sankyo Europe GmbH (2011?2020), the Daiichi Sankyo Europe GmbH and Eli Lilly & Company Alliance (2014?2017), Edwards (2016?2019), Gedeon Richter (2014?2016), Menarini International Operations (2009?2012), MSD-Merck & Co. (2011?2014), Novartis Pharma AG (2014?2020), ResMed (2014?2016), Sanofi (2009?2011), Servier (2009?2021) and Vifor (2019?2022). Conflicts of interest: M.G.C.-L. reports the receipt of personal fees from Novartis, Abbott, MSD and Astellas, and grants from CIBERCV outside the submitted work. L.H.L. reports the receipt of personal fees from Merck, Sanofi, AstraZeneca, Bayer, Pharmacosmos and Abbott Medscape, grants and personal fees from Boehringer Ingelheim, Vifor-Fresenius, Relypsa, Novartis and Mundipharma, and grants from Boston Scientific outside the submitted work. S.D.A. reports the receipt of personal fees from Bayer, BI, Servier, Novartis and Respicardia, grants and personal fees from Vifor, and grants from Abbott Vascular outside the submitted work. R.F. reports the receipt of grants and personal fees from Servier International and Novartis, and personal fees from Merck Serono, Bayer and Boehringer Ingelheim outside the submitted work. A.J.S.C. reports the receipt of personal fees from AstraZeneca, Menarini, Novartis, Nutricia, Respicardia, Servier, Stealth Peptides, Vifor, Actimed, Faraday and WL Gore outside the submitted work. G.F. reports having served on the committees of trials and registries sponsored by Bayer, Novartis, Servier, Vifor, Medtronic and BI outside the submitted work. A.P.M. reports the receipt of personal fees from Bayer, Fresenius and Novartis outside the submitted work. Prior to 2018, F.R. reports the receipt of grants and personal fees from SJM/Abbott, Servier, Novartis and Bayer, and personal fees from Zoll, AstraZeneca, Sanofi, Amgen, BMS, Pfizer, Fresenius, Vifor, Roche, Cardiorentis and Boehringer Ingelheim, other funding from Heartware, and grants from Mars outside the submitted work; since 1 January 2018 F.R. has received no personal payments and all payments have been made to the University of Zurich. M.B.Y. reports the receipt of grants from Novartis, Amgen and Bayer during the conduct of the study. P.M.S. reports the receipt of grants and other research support from the Ministry of Education, Science and Technological Development of the Republic of Serbia, the receipt of honoraria or consultation fees from Servier, Boehringer Ingelheim, Hemofarm, Novartis and AstraZeneca, and has participated in a company-sponsored speakers' bureau for Fondazione Internationale Menarini. M.L., I.M., M.P., T.M., M.F.P., G.M.C.R., D.S., M.A, J.-C.E. and C.L. have nothing to disclose. Since its initiation, the EURObservational Research Programme has been supported by Abbott Vascular International (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), the Bristol‐Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), the Daiichi Sankyo Europe GmbH and Eli Lilly & Company Alliance (2014–2017), Edwards (2016–2019), Gedeon Richter (2014–2016), Menarini International Operations (2009–2012), MSD‐Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), Servier (2009–2021) and Vifor (2019–2022). M.G.C.‐L. reports the receipt of personal fees from Novartis, Abbott, MSD and Astellas, and grants from CIBERCV outside the submitted work. L.H.L. reports the receipt of personal fees from Merck, Sanofi, AstraZeneca, Bayer, Pharmacosmos and Abbott Medscape, grants and personal fees from Boehringer Ingelheim, Vifor‐Fresenius, Relypsa, Novartis and Mundipharma, and grants from Boston Scientific outside the submitted work. S.D.A. reports the receipt of personal fees from Bayer, BI, Servier, Novartis and Respicardia, grants and personal fees from Vifor, and grants from Abbott Vascular outside the submitted work. R.F. reports the receipt of grants and personal fees from Servier International and Novartis, and personal fees from Merck Serono, Bayer and Boehringer Ingelheim outside the submitted work. A.J.S.C. reports the receipt of personal fees from AstraZeneca, Menarini, Novartis, Nutricia, Respicardia, Servier, Stealth Peptides, Vifor, Actimed, Faraday and WL Gore outside the submitted work. G.F. reports having served on the committees of trials and registries sponsored by Bayer, Novartis, Servier, Vifor, Medtronic and BI outside the submitted work. A.P.M. reports the receipt of personal fees from Bayer, Fresenius and Novartis outside the submitted work. Prior to 2018, F.R. reports the receipt of grants and personal fees from SJM/Abbott, Servier, Novartis and Bayer, and personal fees from Zoll, AstraZeneca, Sanofi, Amgen, BMS, Pfizer, Fresenius, Vifor, Roche, Cardiorentis and Boehringer Ingelheim, other funding from Heartware, and grants from Mars outside the submitted work; since 1 January 2018 F.R. has received no personal payments and all payments have been made to the University of Zurich. M.B.Y. reports the receipt of grants from Novartis, Amgen and Bayer during the conduct of the study. P.M.S. reports the receipt of grants and other research support from the Ministry of Education, Science and Technological Development of the Republic of Serbia, the receipt of honoraria or consultation fees from Servier, Boehringer Ingelheim, Hemofarm, Novartis and AstraZeneca, and has participated in a company‐sponsored speakers' bureau for Fondazione Internationale Menarini. M.L., I.M., M.P., T.M., M.F.P., G.M.C.R., D.S., M.A, J.‐C.E. and C.L. have nothing to disclose. Conflicts of interest:

Funders	Funder number
Abbott Vascular International
Daiichi Sankyo Europe GmbH
Eli Lilly & Company Alliance
MSD-Merck & Co.
MSD‐Merck & Co.
Menarini International Operations
Novartis and Mundipharma
Novartis and Respicardia
Pfizer Alliance
ResMed
Respicardia
Vifor
Amgen
Bristol-Myers Squibb
Astellas Pharma US
AstraZeneca
Bayer
Merck
Novartis
Sanofi
Medtronic
Boehringer Ingelheim
Boston Scientific Corporation
Gedeon Richter
Ministarstvo Prosvete, Nauke i Tehnološkog Razvoja
Universität Zürich
Servier
Daiichi Sankyo Europe

Keywords

Age
Hospitalization
Mortality
Registry
Sex

Access to Document

10.1002/ejhf.1645

Cite this

@article{568ae05120604896af50abebdf42c052,

title = "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 = "Aims: This 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. Methods and results: 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. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF ≤45%.",

keywords = "Age, Hospitalization, Mortality, Registry, Sex",

author = "{the European Society of Cardiology Heart Failure Long-Term Registry Investigators Group} and Mitja Lain{\v s}cak and Ivan Milinkovic and Marija Polovina and Crespo-Leiro, {Marisa G.} and Lund, {Lars H.} and Anker, {Stefan D.} and C{\'e}cile Laroche and Roberto Ferrari and Coats, {Andrew J.S.} and Theresa McDonagh and Gerasimos Filippatos and Maggioni, {Aldo P.} and Piepoli, {Massimo F.} and Rosano, {Giuseppe M.C.} and Frank Ruschitzka and Dragan Simic and Milika A{\v s}anin and Eicher, {Jean Christophe} and Yilmaz, {Mehmet B.} and Seferovic, {Petar M.} and Gale, {Christopher Peter} and Chair, {G. B.} and {Branko Beleslin}, {R. S.} and {Andrzej Budaj}, {P. L.} and Chioncel, {R. O.} and {Nikolaos Dagres}, {D. E.} and {Nicolas Danchin}, {F. R.} and {David Erlinge}, {S. E.} and {Jonathan Emberson}, {G. B.} and {Michael Glikson}, {I. L.} and {Alastair Gray}, {G. B.} and {Meral Kayikcioglu}, {T. R.} and {Aldo Maggioni}, {I. T.} and {Klaudia Vivien Nagy}, {H. U.} and {Aleksandr Nedoshivin}, {R. U.} and {Anna-Sonia Petronio}, {I. T.} and {Jolien Roos-Hesselink}, {N. L.} and {Lars Wallentin}, {S. E.} and {Uwe Zeymer}, {D. E.} and A. Mebazaa and A. Coats and {A. Goda}, {A. L.} and {M. Diez}, {A. R.} and {A. Fernandez}, {A. R.} and {F. Fruhwald}, {A. T.} and E. Fazlibegovic and {P. Gatzov}, {B. G.} and {A. Kurlianskaya}, {B. Y.} and {R. Hullin}, {C. H.} and O. Amir",

note = "Publisher Copyright: {\textcopyright} 2019 The Authors. European Journal of Heart Failure {\textcopyright} 2019 European Society of Cardiology",

year = "2020",

month = jan,

day = "1",

doi = "10.1002/ejhf.1645",

language = "אנגלית",

volume = "22",

pages = "92--102",

journal = "European Journal of Heart Failure",

issn = "1388-9842",

publisher = "John Wiley and Sons Ltd",

number = "1",

}

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. / the European Society of Cardiology Heart Failure Long-Term Registry Investigators Group.
In: European Journal of Heart Failure, Vol. 22, No. 1, 01.01.2020, p. 92-102.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Sex- and age-related differences in the management and outcomes of chronic heart failure

T2 - an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

AU - the European Society of Cardiology Heart Failure Long-Term Registry Investigators Group

AU - Lainšcak, Mitja

AU - Milinkovic, Ivan

AU - Polovina, Marija

AU - Crespo-Leiro, Marisa G.

AU - Lund, Lars H.

AU - Anker, Stefan D.

AU - Laroche, Cécile

AU - Ferrari, Roberto

AU - Coats, Andrew J.S.

AU - McDonagh, Theresa

AU - Filippatos, Gerasimos

AU - Maggioni, Aldo P.

AU - Piepoli, Massimo F.

AU - Rosano, Giuseppe M.C.

AU - Ruschitzka, Frank

AU - Simic, Dragan

AU - Ašanin, Milika

AU - Eicher, Jean Christophe

AU - Yilmaz, Mehmet B.

AU - Seferovic, Petar M.

AU - Gale, Christopher Peter

AU - Chair, G. B.

AU - Branko Beleslin, R. S.

AU - Andrzej Budaj, P. L.

AU - Chioncel, R. O.

AU - Nikolaos Dagres, D. E.

AU - Nicolas Danchin, F. R.

AU - David Erlinge, S. E.

AU - Jonathan Emberson, G. B.

AU - Michael Glikson, I. L.

AU - Alastair Gray, G. B.

AU - Meral Kayikcioglu, T. R.

AU - Aldo Maggioni, I. T.

AU - Klaudia Vivien Nagy, H. U.

AU - Aleksandr Nedoshivin, R. U.

AU - Anna-Sonia Petronio, I. T.

AU - Jolien Roos-Hesselink, N. L.

AU - Lars Wallentin, S. E.

AU - Uwe Zeymer, D. E.

AU - Mebazaa, A.

AU - Coats, A.

AU - A. Goda, A. L.

AU - M. Diez, A. R.

AU - A. Fernandez, A. R.

AU - F. Fruhwald, A. T.

AU - Fazlibegovic, E.

AU - P. Gatzov, B. G.

AU - A. Kurlianskaya, B. Y.

AU - R. Hullin, C. H.

AU - Amir, O.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Aims: This 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. Methods and results: 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. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF ≤45%.

AB - Aims: This 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. Methods and results: 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. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF ≤45%.

KW - Age

KW - Hospitalization

KW - Mortality

KW - Registry

KW - Sex

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U2 - 10.1002/ejhf.1645

DO - 10.1002/ejhf.1645

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C2 - 31863522

AN - SCOPUS:85076898519

SN - 1388-9842

VL - 22

SP - 92

EP - 102

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

IS - 1

ER -

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

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