Elderly Women With Heart Failure: Simply Forgotten?
The Euro-Heart Survey on Heart Failure, which enrolled over 10,000 patients with HF admitted at 115 hospitals in Europe, analyzed the data from 6806 patients (mean age 69 years, 41% women) who had undergone a qualitative or quantitative assessment of LVEF. Women were older (mean age 75 vs 68 years), less likely to have coronary artery disease and more likely to have hypertension, diabetes or valvular heart disease than men. Women comprised 55% of the patients with an LVEF ≥0.40 and only 29% of those with an LVEF <0.40. Women were less often treated with angiotensin-coverting enzyme (ACE) inhibitors and β-blockers than men. A remarkable finding of that study was the exclusion from the analysis of more than one-third (3895 patients) of the population enrolled in the Euro-Heart Survey on Heart Failure due to lack of an assessment of LVEF. Two-thirds of these patients had been admitted to a general internal medicine ward, 57% were women, and 45% were women aged 70 years or older.
Another analysis from the Euro-Heart Survey on Heart Failure compared 741 patients hospitalized for HF aged 80 years or older (median age 84 years) with 2836 younger patients (median age 68 years). Octogenarians were more likely to be women (66 vs 44%) and to have HFPEF (39 vs 28%). A higher proportion of octogenarians had hypertension, atrial fibrillation and significant noncardiac comorbidities, including stroke, obstructive pulmonary disease and kidney dysfunction. Octogenarians were less likely to be referred to a cardiology department, to undergo echocardiography and coronary angiography, and to receive optimized ACE inhibitor and β-blocker therapies; the prescription of ACE inhibitors was an independent determinant of a better outcome, as was the prescription of β-blockers for the patients with reduced LVEF. Notably, octogenarians, most of whom were women, were less likely to live in their own home and with their relatives, and more likely to live alone, to need help from healthcare services and to have self-care problems.
In the ADHERE Registry, which included more than 100,000 patients hospitalized for acute decompensated HF at 274 hospitals in the USA, women comprised 51% of all hospital admissions, were older than men (mean age 75 vs 70 years), were more likely to have normal LVEF (51 vs 28%), more frequently had hypertension and less frequently had coronary artery disease.
Taken together, these data show that elderly women – although they may be perceived as a minority – in reality correspond to the majority of HF patients encountered in the community, account for more than 50% of the HF hospital admissions and, despite this, are investigated and treated less intensively than men.
Elderly Women With HF in the Real World
The Euro-Heart Survey on Heart Failure, which enrolled over 10,000 patients with HF admitted at 115 hospitals in Europe, analyzed the data from 6806 patients (mean age 69 years, 41% women) who had undergone a qualitative or quantitative assessment of LVEF. Women were older (mean age 75 vs 68 years), less likely to have coronary artery disease and more likely to have hypertension, diabetes or valvular heart disease than men. Women comprised 55% of the patients with an LVEF ≥0.40 and only 29% of those with an LVEF <0.40. Women were less often treated with angiotensin-coverting enzyme (ACE) inhibitors and β-blockers than men. A remarkable finding of that study was the exclusion from the analysis of more than one-third (3895 patients) of the population enrolled in the Euro-Heart Survey on Heart Failure due to lack of an assessment of LVEF. Two-thirds of these patients had been admitted to a general internal medicine ward, 57% were women, and 45% were women aged 70 years or older.
Another analysis from the Euro-Heart Survey on Heart Failure compared 741 patients hospitalized for HF aged 80 years or older (median age 84 years) with 2836 younger patients (median age 68 years). Octogenarians were more likely to be women (66 vs 44%) and to have HFPEF (39 vs 28%). A higher proportion of octogenarians had hypertension, atrial fibrillation and significant noncardiac comorbidities, including stroke, obstructive pulmonary disease and kidney dysfunction. Octogenarians were less likely to be referred to a cardiology department, to undergo echocardiography and coronary angiography, and to receive optimized ACE inhibitor and β-blocker therapies; the prescription of ACE inhibitors was an independent determinant of a better outcome, as was the prescription of β-blockers for the patients with reduced LVEF. Notably, octogenarians, most of whom were women, were less likely to live in their own home and with their relatives, and more likely to live alone, to need help from healthcare services and to have self-care problems.
In the ADHERE Registry, which included more than 100,000 patients hospitalized for acute decompensated HF at 274 hospitals in the USA, women comprised 51% of all hospital admissions, were older than men (mean age 75 vs 70 years), were more likely to have normal LVEF (51 vs 28%), more frequently had hypertension and less frequently had coronary artery disease.
Taken together, these data show that elderly women – although they may be perceived as a minority – in reality correspond to the majority of HF patients encountered in the community, account for more than 50% of the HF hospital admissions and, despite this, are investigated and treated less intensively than men.
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