Male sex was associated with a 40% higher risk of adverse outcomes in elderly patients with HFmrEF/HFpEF (HR 1.40, 95% CI 1.13-1.73).
Male sex and advanced age (>80 years) are independent predictors of worse clinical outcomes in elderly patients with HFmrEF/HFpEF.
Absolute Event Rate: 0% vs 0%
Abstract Background Heart failure with preserved or mildly reduced ejection fraction (HFmrEF/HFpEF) is a complex syndrome common in elderly patients with multiple comorbidities. Age and sex affect the clinical phenotypes and outcomes of this condition. Purpose This study aims to identify age- and sex-specific factors influencing prognosis in elderly patients with HFmrEF/HFpEF, to improve risk stratification and guide personalized treatment. Methods This observational, ambispective study was conducted at Papa Giovanni XXIII Hospital, Bergamo, from June 2017 to August 2022, enrolling patients 65 years with HFmrEF/HFpEF (NYHA class II-IV) according to ESC guidelines. Data collected included demographics, medical history, echocardiograms, and lab tests. Follow-up lasted at least one year, with outcomes defined as a composite of all-cause death, urgent heart transplant, HF hospitalization, and Emergency Department (ED) referral for decompensated HF. Findings were validated using the Swedish HF registry with a similar cohort. Results Among 2,263 HF patients, 971 HFmrEF/HFpEF patients (56.8% males, mean age 79.2) were analyzed. Males had a higher prevalence of cardiovascular risk factors (e.g., diabetes, obesity, coronary artery disease). The composite outcome occurred more frequently in males (20.6 vs 17.14 per 100 patient years; IRR=1.20, p=0.035). Multivariable analysis identified male sex (HR 1.40, 95% CI 1.13–1.73), age 80 (HR 1.91, 95% CI 1.22–3.00), higher NYHA class, chronic kidney disease, and severe valvular heart disease as independent predictors of worse outcomes. Males had a 40% higher risk of the outcome compared to women (HR 1.40, 95% CI 1.13-1.73), while patients 80 years old had nearly double the risk compared to those aged 65-70 (HR 1.91, 95% CI 1.22-3.00). The validation analysis in the SwedeHF, adapting the same multiple Cox regression model on 20,950 selected patients, median age 79 years and 57.8% men, and observed between January 2017 and August 2022, showed similar independent risk factors for the composite outcome. Conclusions This study highlights significant sex disparities in elderly HFmrEF/HFpEF patients, with higher age and male sex being an independent predictor for poor outcomes. These findings emphasize the need for personalized treatment strategies based on these demographic factors.
D’Elia et al. (Thu,) reported a other. Male sex was associated with a 40% higher risk of adverse outcomes in elderly patients with HFmrEF/HFpEF (HR 1.40, 95% CI 1.13-1.73).