Prognosis and Prognostic Factors of Elderly Patients With Chronic Heart Failure—A Report From the CHART-2 Study

Background: Heart failure (HF) in the elderly has become an emerging healthcare issue in Japan. Methods and Results: We examined prognosis and prognostic factors in 4876 consecutive Stage C/D HF patients (mean 69 years-old, female 32%) in our CHART-2 Study by dividing them into 3 subgroups by age (G1, ≤64 years, n = 1521; G2, 65–74, n = 1510; and G3, ≥75, n = 1845). From G1 to G3, the prevalence of female (23, 31, to 40%), left ventricular ejection fraction (mean 55, 57, to 58%), and plasma BNP levels (median 63, 93, to 158 pg/mL) increased (all P < .001). Similarly, the incidence of death increased (23, 45, to 113/1000 person-years) (P < .001), in which female patients had significantly lower non-cardiovascular mortality (/1000 person-years) than males in G2 (14.9 vs 21.8, P = .027) and G3 (39.2 vs 55.9, P < .001), but not in G1 (5.0 vs 8.0, P = .142). Multivariable Cox regression analysis showed that age, body mass index, BNP, hemoglobin, and albumin were associated with increased all-cause mortality in G3 regardless of sex. Importantly, in G3, history of stroke was associated with increased mortality only in males, and history of atrial fibrillation only in females, while lower albumin level was associated with increased cardiovascular mortality only in females and non-cardiovascular mortality only in males. Conclusions: These results suggest that sex differences exist in prognosis and prognostic factors in elderly HF patients.