Heart Failure: Sex & Age Linked to Worse Outcomes in Elderly Patients

New research indicates that older men with certain types of heart failure face a heightened risk of poor outcomes. A study published in ESC Heart Failure in January 2026, highlights significant sex-based disparities in elderly patients diagnosed with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). The findings point to male sex and increasing age as key predictors of adverse events in this population.

Understanding HFmrEF and HFpEF

Heart failure is a complex condition where the heart struggles to pump enough blood to meet the body’s needs. Traditionally, heart failure was categorized as either systolic heart failure (reduced ejection fraction) or diastolic heart failure (preserved ejection fraction). Still, there’s a growing recognition of an intermediate category, HFmrEF. The National Institutes of Health (NIH) explains that HFpEF, previously known as diastolic heart failure, is defined by a left ventricular ejection fraction within the normal range, but still accompanied by symptoms of heart failure. Ejection fraction refers to the percentage of blood the left ventricle pumps out with each contraction. HFmrEF falls between these two extremes, with a mildly reduced ejection fraction.

Distinguishing between these types of heart failure is crucial because treatment approaches can differ. However, current treatment options for HFpEF remain limited, and outcomes are often poorer compared to heart failure with reduced ejection fraction.

The Study Findings: Sex and Age as Risk Factors

The recent study, published in ESC Heart Failure, investigated outcomes in a cohort of elderly patients with HFmrEF/HFpEF. Researchers found that male patients consistently experienced worse outcomes than their female counterparts. The risk of adverse events increased with age in both sexes, but the effect was particularly pronounced in men. While the study doesn’t detail the specific sample size or methods used, the core finding underscores a vulnerability within this demographic.

It’s significant to note that this study identifies associations, not necessarily causation. The observed link between male sex, older age, and poorer outcomes doesn’t definitively prove that one causes the other. Other underlying factors, such as differences in co-existing health conditions, lifestyle factors, or access to care, could contribute to the observed disparities.

What Does This Mean for Patients?

These findings don’t mean that all older men with HFmrEF/HFpEF will experience poor outcomes. Rather, they highlight the need for increased awareness among clinicians and patients. For older men diagnosed with these conditions, a proactive approach to managing risk factors – such as high blood pressure, diabetes, and obesity – is particularly important.

It also suggests a need for more personalized treatment strategies. Traditional heart failure therapies may not be equally effective in all patients, and tailoring treatment plans based on sex and age could potentially improve outcomes. However, more research is needed to determine the optimal approach.

Guidance Updates and Emerging Evidence

The European Society of Cardiology (ESC) recently issued a focused update to its heart failure guidelines in August 2023, incorporating new evidence from randomized controlled trials. This update addresses changes in recommendations for the treatment of HFmrEF, HFpEF, and related conditions. While the update doesn’t specifically address the sex-based disparities highlighted in the recent study, it reflects the ongoing evolution of our understanding of heart failure and the need for evidence-based treatment strategies.

The 2023 ESC update considered evidence published up to March 2023, and focused on changes that would lead to Class IIa and I recommendations – indicating a strong level of evidence supporting the recommendations. This continuous refinement of guidelines is a crucial part of improving patient care.

Contextualizing the Risk

Understanding risk requires considering both absolute and relative risk. Relative risk compares the likelihood of an event occurring in one group versus another. Absolute risk, represents the actual probability of an event occurring in a population. Without specific data from the study regarding absolute risk, it’s difficult to fully appreciate the magnitude of the risk associated with male sex and older age. However, the study’s findings suggest that these factors are significant contributors to adverse outcomes in this patient population.

What Comes Next: Research and Surveillance

Further research is essential to unravel the underlying mechanisms driving the observed sex-based disparities. Studies are needed to investigate potential biological differences between men and women that may influence their response to heart failure therapies. Research should focus on identifying modifiable risk factors that could mitigate the increased risk in older men.

Ongoing surveillance of heart failure incidence and outcomes is also crucial. Public health agencies and healthcare systems should continue to monitor trends in HFmrEF/HFpEF, paying particular attention to disparities across different demographic groups. This information can inform the development of targeted prevention and treatment strategies.

The American Heart Association (AHA) also publishes guidelines for the management of heart failure. The 2022 AHA/ACC/HFSA Guideline provides a comprehensive overview of current best practices.

addressing the challenges posed by HFmrEF/HFpEF requires a collaborative effort involving researchers, clinicians, policymakers, and patients. By working together, we can strive to improve outcomes and enhance the quality of life for individuals living with this complex condition.