HMN 2026: How Male sex, older age predict poor outcomes in seniors with HFmrEF/HFpEF

Considerable sex disparities are reported in elderly patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), with male sex and older age predicting poor outcomes, according to a study published online Jan. 8 in ESC Heart Failure.

Emilia D’Elia, M.D., Ph.D., from the Papa Giovanni XXIII Hospital in Bergamo, Italy, and colleagues conducted an observational, ambispective study involving 971 patients aged older than 65 years with HFmrEF/HFpEF to identify age- and sex-specific factors influencing prognosis.

The researchers found that the prevalence of cardiovascular risk factors was higher for men (e.g., diabetes, obesity, coronary artery disease). The composite outcome of all-cause death, urgent heart transplant, HF hospitalization, and emergency department referral for decompensated HF occurred more frequently in men (20.6 versus 17.14 per 100 patient-years; incidence rate ratio, 1.20).

In a multivariable analysis, independent predictors of worse outcomes included male sex (hazard ratio, 1.40), age older than 80 years (versus age 65 to 70 years; hazard ratio, 1.91), higher New York Heart Association class, chronic kidney disease, and severe valvular disease. Similar independent risk factors for the composite outcome were seen in a validation analysis in the SwedeHF registry, adapting the same multiple Cox regression model on 20,950 selected patients.

“Our study revealed notable differences in clinical characteristics and outcomes based on sex and age, emphasizing the importance of considering these factors in patient management,” the authors write.

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