@article{3105251,
    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",
    author = "Lainšcak, M. and Milinkovic, I. and Polovina, M. and Crespo-Leiro, M.G. and Lund, L.H. and Anker, S.D. and Laroche, C. and Ferrari, R. and Coats, A.J.S. and McDonagh, T. and Filippatos, G. and Maggioni, A.P. and Piepoli, M.F. and Rosano, G.M.C. and Ruschitzka, F. and Simic, D. and Ašanin, M. and Eicher, J.-C. and Yilmaz, M.B. and Seferovic, P.M. and Gale, C.P. 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 Mebazaa, A. and Coats, A. and A. Goda, A.L. and M. Diez, A.R. and A. Fernandez, A.R. and F. Fruhwald, A.T. and Fazlibegovic, E. and P. Gatzov, B.G. and A. Kurlianskaya, B.Y. and R. Hullin, C.H. and T. Christodoulides, C.Y. and J. Hradec, C.Z. and O. Wendelboe Nielsen, D.K. and R. Nedjar, D.Z. and T. Uuetoa, E.E. and M. Hassanein, E.G. and J. F. Delgado Jimenez, E.S. and V-P. Harjola, F.I. and D. Logeart, F.R. and V. Chumburidze, G.E. and D. Tousoulis, G.R. and D. Milicic, H.R. and B. Merkely, H.U. and O'Donoghue IE, E. and O. Amir, I.L. and A. Shotan, I.L. and D. Shafie, I.R. and M. Metra, I.T. and A. Matsumori, J.P. and E. Mirrakhimov, K.G. and A. Kavoliuniene, L.T. and A. Erglis, L.V. and Vataman, E. and M. Otljanska, M.K. and E. Srbinovska Kostovska, M.K. and D. Cassar DeMarco, M.T. and J. Drozdz, P.L. and Fonseca, C. and M. Dekleva, R.S. and E. Shkolnik, R.U. and U. Dahlstrom, S.E. and M. Lainscak, S.I. and E. Goncalvesova, S.K. and A. Temizhan, T.R. and V. Estrago, U.Y. and G. Bajraktari, X.K. and Auer, J. and Ablasser, K. and Fruhwald, F. and Dolze, T. and Brandner, K. and Gstrein, S. and Poelzl, G. and Moertl, D. and Reiter, S. and Podczeck-Schweighofer, A. and Muslibegovic, A. and Vasilj, M. and Cesko, M. and Zelenika, D. and Palic, B. and Pravdic, D. and Cuk, D. and Vitlianova, K. and Katova, T. and Velikov, T. and Kurteva, T. and Gatzov, P. and Kamenova, D. and Antova, M. and Sirakova, V. and Krejci, J. and Mikolaskova, M. and Spinar, J. and Krupicka, J. and Malek, F. and Hegarova, M. and Lazarova, M. and Monhart, Z. and Hassanein, M. and Sobhy, M. and El Messiry, F. and El Shazly, A.H. and Elrakshy, Y. and Youssef, A. and Moneim, A.A. and Noamany, M. and Reda, A. and Dayem, T.K.A. and Farag, N. and Halawa, S.I. and Hamid, M.A. and Said, K. and Saleh, A. and Ebeid, H. and Hanna, R. and Aziz, R. and Louis, O. and Enen, M.A. and Ibrahim, B.S. and Nasr, G. and Elbahry, A. and Sobhy, H. and Ashmawy, M. and Gouda, M. and Aboleineen, W. and Bernard, Y. and Luporsi, P. and Meneveau, N. and Pillot, M. and Morel, M. and Seronde, M.-F. and Schiele, F. and Briand, F. and Delahaye, F. and Damy, T. and de Groote, P. and Fertin, M. and Lamblin, N. and Isnard, R. and Lefol, C. and Thevenin, S. and Hagege, A. and Jondeau, G. and Logeart, D. and Le Marcis, V. and Ly, J.-F. and Coisne, D. and Lequeux, B. and Le Moal, V. and Mascle, S. and Lotton, P. and Behar, N. and Donal, E. and Thebault, C. and Ridard, C. and Reynaud, A. and Basquin, A. and Bauer, F. and Codjia, R. and Galinier, M. and Tourikis, P. and Stavroula, M. and Tousoulis, D. and Stefanadis, C. and Chrysohoou, C. and Kotrogiannis, I. and Matzaraki, V. and Dimitroula, T. and Karavidas, A. and Tsitsinakis, G. and Kapelios, C. and Nanas, J. and Kampouri, H. and Nana, E. and Kaldara, E. and Eugenidou, A. and Vardas, P. and Saloustros, I. and Patrianakos, A. and Tsaknakis, T. and Evangelou, S. and Nikoloulis, N. and Tziourganou, H. and Tsaroucha, A. and Papadopoulou, A. and Douras, A. and Polgar, L. and Merkely, B. and Kosztin, A. and Nyolczas, N. and Nagy, A.C. and Halmosi, R. and Elber, J. and Alony, I. and Shotan, A. and Fuhrmann, A.V. and Amir, O. and Romano, S. and Marcon, S. and Penco, M. and Di Mauro, M. and Lemme, E. and Carubelli, V. and Rovetta, R. and Metra, M. and Bulgari, M. and Quinzani, F. and Lombardi, C. and Bosi, S. and Schiavina, G. and Squeri, A. and Barbieri, A. and Di Tano, G. and Pirelli, S. and Fucili, A. and Passero, T. and Musio, S. and Di Biase, M. and Correale, M. and Salvemini, G. and Brognoli, S. and Zanelli, E. and Giordano, A. and Agostoni, P. and Italiano, G. and Salvioni, E. and Copelli, S. and Modena, M.G. and Reggianini, L. and Valenti, C. and Olaru, A. and Bandino, S. and Deidda, M. and Mercuro, G. and Dessalvi, C.C. and Marino, P.N. and Di Ruocco, M.V. and Sartori, C. and Piccinino, C. and Parrinello, G. and Licata, G. and Torres, D. and Giambanco, S. and Busalacchi, S. and Arrotti, S. and Novo, S. and Inciardi, R.M. and Pieri, P. and Chirco, P.R. and Galifi, M.A. and Teresi, G. and Buccheri, D. and Minacapelli, A. and Veniani, M. and Frisinghelli, A. and Priori, S.G. and Cattaneo, S. and Opasich, C. and Gualco, A. and Pagliaro, M. and Mancone, M. and Fedele, F. and Cinque, A. and Vellini, M. and Scarfo, I. and Romeo, F. and Ferraiuolo, F. and Sergi, D. and Anselmi, M. and Melandri, F. and Leci, E. and Iori, E. and Bovolo, V. and Pidello, S. and Frea, S. and Bergerone, S. and Botta, M. and Canavosio, F.G. and Gaita, F. and Merlo, M. and Cinquetti, M. and Sinagra, G. and Ramani, F. and Fabris, E. and Stolfo, D. and Artico, J. and Miani, D. and Fresco, C. and Daneluzzi, C. and Proclemer, A. and Cicoira, M. and Zanolla, L. and Marchese, G. and Torelli, F. and Vassanelli, C. and Voronina, N. and Erglis, A. and Tamakauskas, V. and Smalinskas, V. and Karaliute, R. and Petraskiene, I. and Kazakauskaite, E. and Rumbinaite, E. and Kavoliuniene, A. and Vysniauskas, V. and Brazyte-Ramanauskiene, R. and Petraskiene, D. and Stankala, S. and Switala, P. and Juszczyk, Z. and Sinkiewicz, W. and Gilewski, W. and Pietrzak, J. and Orzel, T. and Kasztelowicz, P. and Kardaszewicz, P. and Lazorko-Piega, M. and Gabryel, J. and Mosakowska, K. and Bellwon, J. and Rynkiewicz, A. and Raczak, G. and Lewicka, E. and Dabrowska-Kugacka, A. and Bartkowiak, R. and Sosnowska-Pasiarska, B. and Wozakowska-Kaplon, B. and Krzeminski, A. and Zabojszcz, M. and Mirek-Bryniarska, E. and Grzegorzko, A. and Bury, K. and Nessler, J. and Zalewski, J. and Furman, A. and Broncel, M. and Poliwczak, A. and Bala, A. and Zycinski, P. and Rudzinska, M. and Jankowski, L. and Kasprzak, J.D. and Michalak, L. and Soska, K.W. and Drozdz, J. and Huziuk, I. and Retwinski, A. and Flis, P. and Weglarz, J. and Bodys, A. and Grajek, S. and Kaluzna-Oleksy, M. and Straburzynska-Migaj, E. and Dankowski, R. and Szymanowska, K. and Grabia, J. and Szyszka, A. and Nowicka, A. and Samcik, M. and Wolniewicz, L. and Baczynska, K. and Komorowska, K. and Poprawa, I. and Komorowska, E. and Sajnaga, D. and Zolbach, A. and Dudzik-Plocica, A. and Abdulkarim, A.-F. and Lauko-Rachocka, A. and Kaminski, L. and Kostka, A. and Cichy, A. and Ruszkowski, P. and Splawski, M. and Fitas, G. and Szymczyk, A. and Serwicka, A. and Fiega, A. and Zysko, D. and Krysiak, W. and Szabowski, S. and Skorek, E. and Pruszczyk, P. and Bienias, P. and Ciurzynski, M. and Welnicki, M. and Mamcarz, A. and Folga, A. and Zielinski, T. and Rywik, T. and Leszek, P. and Sobieszczanska-Malek, M. and Piotrowska, M. and Kozar-Kaminska, K. and Komuda, K. and Wisniewska, J. and Tarnowska, A. and Balsam, P. and Marchel, M. and Opolski, G. and Kaplon-Cieslicka, A. and Gil, R.J. and Mozenska, O. and Byczkowska, K. and Gil, K. and Pawlak, A. and Michalek, A. and Krzesinski, P. and Piotrowicz, K. and Uzieblo-Zyczkowska, B. and Stanczyk, A. and Skrobowski, A. and Ponikowski, P. and Jankowska, E. and Rozentryt, P. and Polonski, L. and Gadula-Gacek, E. and Nowalany-Kozielska, E. and Kuczaj, A. and Kalarus, Z. and Szulik, M. and Przybylska, K. and Klys, J. and Prokop-Lewicka, G. and Kleinrok, A. and Aguiar, C.T. and Ventosa, A. and Pereira, S. and Faria, R. and Chin, J. and De Jesus, I. and Santos, R. and Silva, P. and Moreno, N. and Queirós, C. and Lourenço, C. and Pereira, A. and Castro, A. and Andrade, A. and Guimaraes, T.O. and Martins, S. and Placido, R. and Lima, G. and Brito, D. and Francisco, A.R. and Cardiga, R. and Proenca, M. and Araujo, I. and Marques, F. and Moura, B. and Leite, S. and Campelo, M. and Silva-Cardoso, J. and Rodrigues, J. and Rangel, I. and Martins, E. and Correia, A.S. and Peres, M. and Marta, L. and da Silva, G.F. and Severino, D. and Durao, D. and Leao, S. and Magalhaes, P. and Moreira, I. and Cordeiro, A.F. and Ferreira, C. and Araujo, C. and Ferreira, A. and Baptista, A. and Radoi, M. and Bicescu, G. and Vinereanu, D. and Sinescu, C.-J. and Macarie, C. and Popescu, R. and Daha, I. and Dan, G.-A. and Stanescu, C. and Dan, A. and Craiu, E. and Nechita, E. and Aursulesei, V. and Christodorescu, R. and Otasevic, P. and Simeunovic, D. and Ristic, A.D. and Celic, V. and Pavlovic-Kleut, M. and Lazic, J.S. and Stojcevski, B. and Pencic, B. and Stevanovic, A. and Andric, A. and Iric-Cupic, V. and Jovic, M. and Davidovic, G. and Milanov, S. and Mitic, V. and Atanaskovic, V. and Antic, S. and Pavlovic, M. and Stanojevic, D. and Stoickov, V. and Ilic, S. and Ilic, M.D. and Petrovic, D. and Stojsic, S. and Kecojevic, S. and Dodic, S. and Adic, N.C. and Cankovic, M. and Stojiljkovic, J. and Mihajlovic, B. and Radin, A. and Radovanovic, S. and Krotin, M. and Klabnik, A. and Goncalvesova, E. and Pernicky, M. and Murin, J. and Kovar, F. and Kmec, J. and Semjanova, H. and Strasek, M. and Iskra, M.S. and Ravnikar, T. and Suligoj, N.C. and Komel, J. and Fras, Z. and Jug, B. and Glavic, T. and Losic, R. and Bombek, M. and Krajnc, I. and Krunic, B. and Horvat, S. and Kovac, D. and Rajtman, D. and Cencic, V. and Letonja, M. and Winkler, R. and Valentincic, M. and Melihen-Bartolic, C. and Bartolic, A. and Vrckovnik, M.P. and Kladnik, M. and Pusnik, C.S. and Marolt, A. and Klen, J. and Drnovsek, B. and Leskovar, B. and Anguita, M.J.F. and Page, J.C.G. and Martinez, F.M.S. and Andres, J. and Bayes-Genis, A. and Mirabet, S. and Mendez, A. and Garcia-Cosio, L. and Roig, E. and Leon, V. and Gonzalez-Costello, J. and Muntane, G. and Garay, A. and Alcade-Martinez, V. and Fernandez, S.L. and Rivera-Lopez, R. and Puga-Martinez, M. and Fernandez-Alvarez, M. and Serrano-Martinez, J.L. and Grille-Cancela, Z. and Marzoa-Rivas, R. and Blanco-Canosa, P. and Paniagua-Martin, M.J. and Barge-Caballero, E. and Cerdena, I.L. and Baldomero, I.F.H. and Padron, A.L. and Rosillo, S.O. and Gonzalez-Gallarza, R.D. and Montanes, O.S. and Manjavacas, A.M.I. and Conde, A.C. and Araujo, A. and Soria, T. and Garcia-Pavia, P. and Gomez-Bueno, M. and Cobo-Marcos, M. and Alonso-Pulpon, L. and Cubero, J.S. and Sayago, I. and Gonzalez-Segovia, A. and Briceno, A. and Subias, P.E. and Hernandez, M.V. and Cano, M.J.R. and Sanchez, M.A.G. and Jimenez, J.F.D. and Garrido-Lestache, E.B. and Pinilla, J.M.G. and de la Villa, B.G. and Sahuquillo, A. and Marques, R.B. and Calvo, F.T. and Perez-Martinez, M.T. and Gracia-Rodenas, M.R. and Garrido-Bravo, I.P. and Pastor-Perez, F. and Pascual-Figal, D.A. and Molina, B.D. and Orus, J. and Gonzalo, F.E. and Bertomeu, V. and Valero, R. and Martinez-Abellan, R. and Quiles, J. and Rodrigez-Ortega, J.A. and Mateo, I. and ElAmrani, A. and Fernandez-Vivancos, C. and Valero, D.B. and Almenar-Bonet, L. and Sanchez-Lazaro, I.J. and Marques-Sule, E. and Facila-Rubio, L. and Perez-Silvestre, J. and Garcia-Gonzalez, P. and Ridocci-Soriano, F. and Garcia-Escriva, D. and Pellicer-Cabo, A. and de la Fuente Galan, L. and Diaz, J.L. and Platero, A.R. and Arias, J.C. and Blasco-Peiro, T. and Julve, M.S. and Sanchez-Insa, E. and Aured-Guallar, C. and Portoles-Ocampo, A. and Melin, M. and Hägglund, E. and Stenberg, A. and Lindahl, I.-M. and Asserlund, B. and Olsson, L. and Dahlström, U. and Afzelius, M. and Karlström, P. and Tengvall, L. and Wiklund, P.-A. and Olsson, B. and Kalayci, S. and Temizhan, A. and Cavusoglu, Y. and Gencer, E. and Gunes, H. and the European Society of Cardiology Heart Failure Long-Term Registry Investigators Group",
    journal = "European Journal of Heart Failure",
    year = "2020",
    volume = "22",
    number = "1",
    pages = "92-102",
    publisher = "John Wiley and Sons Ltd",
    doi = "10.1002/ejhf.1645",
    keywords = "angiotensin receptor antagonist;  anticoagulant agent;  beta adrenergic receptor blocking agent;  calcium channel blocking agent;  dipeptidyl carboxypeptidase inhibitor;  diuretic agent;  mineralocorticoid antagonist, age distribution;  aged;  aging;  all cause mortality;  aortic stenosis;  Article;  atrial fibrillation;  body mass;  controlled study;  depression;  drug efficacy;  drug response;  female;  heart failure;  heart left ventricle ejection fraction;  hospitalization;  human;  kidney disease;  liver dysfunction;  major clinical study;  male;  prescription;  prevalence;  priority journal;  risk assessment;  risk factor;  sex difference;  systolic blood pressure;  treatment outcome;  very elderly;  heart failure;  heart left ventricle function;  heart stroke volume;  register, Aged;  Angiotensin-Converting Enzyme Inhibitors;  Female;  Heart Failure;  Hospitalization;  Humans;  Male;  Registries;  Stroke Volume;  Ventricular Function, Left",
    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%. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology"
}