Age-related disparities in heart failure: insights into clinical profiles, treatment gaps, and outcomes from a multi-center and multi-ethnic study

A.Z. Y., Koh and B. K., Chung and Hwei Sung, Ling and C. Z. F., Chua and W. K., Ho and K. C., Cheah and S. L., Kwa and J., Namasoo and C. H., Chai and P. W., Ting and M. J., Khaw and J. K. W., Wong and L. Y., Ting and S. Y., Chai and R.S.L., Chew (2025) Age-related disparities in heart failure: insights into clinical profiles, treatment gaps, and outcomes from a multi-center and multi-ethnic study. European Journal of Heart Failure, 27 (Supp.2). pp. 114-115. ISSN 1879-0844

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Abstract

Background: Heart failure (HF) is a significant cause of morbidity and mortality. Differences in clinical characteristics and treatment outcomes between elderly and younger patients remain underexplored. Purpose: To evaluate disparities in demographics, comorbidities, prescription of guideline-directed medical therapy (GDMT), and clinical outcomes in elderly versus younger HFrEF patients. Methods: A retrospective, multi-center cohort study analyzed 578 HF patients who attend dedicated HF clinics in ten hospitals between January 1, 2021, and June 30, 2023, categorized into elderly (≥65 years, n=176) and younger (<65 years, n=402) groups. Data included demographics, comorbidities, EF, New York Heart Association (NYHA) functional class, GDMT prescription at baseline, 3 months, and 6 months, and clinical outcomes, including hospitalizations and mortality. Results: Elderly HF patients demonstrated notable differences compared to younger patients in several demographic, clinical, and outcome measures. They had a higher proportion of females (34.7% vs. 19.2%, p<0.001) and exhibited a greater prevalence of comorbidities, including hypertension (76.6% vs. 63.9%, p=0.003), diabetes (47.4% vs. 36.8%, p=0.017), dyslipidemia (63.6% vs. 48.3%, p<0.001), atrial fibrillation (36.2% vs. 17.5%, p<0.001), chronic kidney disease (41.9% vs. 21.2%, p<0.001), and anemia (39.4% vs. 22%, p<0.001). Regarding cardiac function, elderly patients had a higher proportion of EF > 40% (16.1% vs. 9.8%, p=0.007), with 6.9% having EF 41-49% and 9.2% EF ≥ 50%, compared to 6.8% and 3%, respectively, in younger patients. Baseline EF was significantly lower in younger patients (32.4±12.4% vs. 28.1±9.9%, p=0.041), though both groups showed comparable improvements over six months. In terms of guideline-directed medical therapy (GDMT), elderly patients achieving lower RAAS inhibitor prescriptions at three months (81% vs. 88.1%, p=0.034). Elderly patients had fewer 3-pillars and 4-pillars GDMT than younger patients at three months (74.5% vs. 84.0%, p=0.044) and 6 months (75.1% vs. 86.0%, p=0.005). Outcomes revealed that elderly patients had higher six-month mortality rates (12.7% vs. 5.9%, p=0.007), although heart failure hospitalization rates were similar between the groups (6.2% vs. 9.1%, p=0.219). Conclusion: Elderly HF patients face greater challenges in managing comorbidities and achieving optimal GDMT prescription, contributing to higher mortality rates. Tailored interventions are needed to improve outcomes in this high-risk population.

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