Online first
Original Article
Published online: 2024-01-18

open access

Page views 458
Article views/downloads 128
Get Citation

Connect on Social Media

Connect on Social Media

Gender differences in clinical features and outcomes of patients over 75 years presenting with acute heart failure. Results of a nationwide study (2016–2019)

María Anguita-Gámez1, Alberto Esteban-Fernández2, Juan L. Bonilla-Palomas3, José L. Bernal4, Náyade del Prado4, Cristina Fernández-Pérez4, Francisco J. Elola-Somoza4, Manuel Anguita-Sánchez5
Pubmed: 38247437


Background: Heart failure (HF) is a major health problem in Western countries, and a leading cause of hospitalizations and death. There is a scarcity of data on the influence of sex on HF outcomes in elderly patients. The aim of the present study was to analyze differences between men and women in clinical characteristics, in-hospital mortality, 30-day HF readmission rates, cardiovascular mortality and HF readmission rates at 1 year after discharge in patients older than 75 years hospitalized for HF in Spain.

Methods: Retrospective analysis of patients discharged with a main diagnosis of HF from all Spanish public hospitals between 2016 and 2019. Patients aged 75 years or older were selected, and a comparison was made between male and female patients.

Results: From 2016 to 2019, a total of 354,786 episodes of HF in this age subgroup were identified, 59.2% being women. The overall mean age was 85.2 ± 5.4 years, being higher in women (85.9 ± 5.5 vs. 84.2 ± 5.3 years, p < 0.001). Risk-adjusted in-hospital mortality was lower in women (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.92–0.97; p < 0.001). Female sex also showed a protective effect for 30-day readmissions, with an OR of 1.06 (95% CI: 1.04–1.09; p < 0.001). One-year cardiovascular mortality (24.1% vs. 25.0%; p < 0.001) and one-year HF readmission rates (30.8% vs. 31.6%; p = 0.001) were lower in women.

Conclusions: Almost 60% of hospital admissions for HF in people aged 75 years or older between 2016 and 2019 in Spain were female patients. Female sex seems to play a protective role on in-hospital mortality and the rate of admissions and mortality at 1 year after discharge.

Article available in PDF format

View PDF Download PDF file


  1. Ziaeian B, Fonarow GC, et al. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016; 13(6): 368–378.
  2. Sayago-Silva I, García-López F, Segovia-Cubero J. Epidemiology of heart failure in Spain over the last 20 years. Rev Esp Cardiol (Engl Ed). 2013; 66(8): 649–656.
  3. Anguita Sánchez M, Crespo Leiro MG, de Teresa Galván E, et al. Prevalence of heart failure in the Spanish general population aged over 45 years. The PRICE Study. Rev Esp Cardiol. 2008; 61(10): 1041–1049.
  4. Fröhlich H, Rosenfeld N, Täger T, et al. Epidemiology and long-term outcome in outpatients with chronic heart failure in Northwestern Europe. Heart. 2019; 105(16): 1252–1259.
  5. Bonilla-Palomas JL, Anguita-Sánchez MP, Elola-Somoza FJ, et al. Thirteen-year trends in hospitalization and outcomes of patients with heart failure in Spain. Eur J Clin Invest. 2021; 51(11): e13606.
  6. Tsao CW, Lyass A, Enserro D, et al. Temporal trends in the incidence of and Mortality associated with heart failure with preserved and reduced ejection fraction. JACC Heart Fail. 2018; 6(8): 678–685.
  7. Lainščak M, Milinković I, Polovina M, et al. 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. Eur J Heart Fail. 2020; 22(1): 92–102.
  8. Escobar C, Varela L, Palacios B, et al. Costs and healthcare utilisation of patients with heart failure in Spain. BMC Health Serv Res. 2020; 20(1): 964.
  9. Lam CSP, Arnott C, Beale AL, et al. Sex differences in heart failure. Eur Heart J. 2019; 40(47): 3859–3868c.
  10. Garay A, Tapia J, Anguita M, et al. Gender differences in health-related quality of life in patients with systolic heart failure: results of the VIDA multicenter study. J Clin Med. 2020; 9(9): 2825–2832.
  11. Jiménez-Navarro MF, Ramirez-Marrero MA, Anguita-Sánchez M, et al. Influence of gender on long-term prognosis of patients with chronic heart failure seen in heart failure clinics. Clin Cardiol. 2010; 33(3): E13–E18.
  12. Goldstein SD. League tables and their limitations: statistical aspects of institutional performance. J R Stat Soc. 1996: 385–444.
  13. Normand SL, Glickman M, Gatsonis C. Statistical methods for profiling providers of medical care: issues and applications. J Am Stat Assoc. 1997; 92(439): 803–814.
  14. Pope GC, Ellis RP, Ash AS, et al. Principal inpatient diagnostic cost group model for Medicare risk adjustment. Health Care Financ Rev. 2000; 21(3): 93–118.
  15. Dewan P, Rørth R, Jhund PS, et al. Differential impact of heart failure with reduced ejection fraction on men and women. J Am Coll Cardiol. 2019; 73(1): 29–40.