Lam Carolyn S P, Piña Ileana L, Zheng Yinggan, Bonderman Diana, Pouleur Anne-Catherine, Saldarriaga Clara, Pieske Burkert, Blaustein Robert O, Nkulikiyinka Richard, Westerhout Cynthia M, Armstrong Paul W
National Heart Centre Singapore and Duke-National University of Singapore, Singapore, Singapore.
Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
JACC Heart Fail. 2023 Sep;11(9):1246-1257. doi: 10.1016/j.jchf.2023.06.020. Epub 2023 Aug 9.
Age and sex influence treatment and outcomes in patients with heart failure (HF).
The authors examined the associations of age and sex with clinical characteristics, background therapies, outcomes, and response to vericiguat in this post hoc analysis of 5,050 VICTORIA (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction) patients with HF and reduced ejection fraction; 1,568 (31%) were ≥75 years of age, of whom 445 (24%) were women.
Clinical characteristics were compared across age (<65, 65 to <75, and ≥75 years) and sex. The treatment effect of vericiguat was estimated by age and sex on the primary composite outcome (time to first HF hospitalization or cardiovascular death) using Cox proportional hazards regression.
Compared with younger patients, those ≥75 years of age had more class III and IV symptoms, higher N-terminal pro-B-type natriuretic peptide levels, and worse kidney function but had the lowest use of triple therapy. No sex differences in triple therapy existed by age, but achieving target doses of triple therapy was less likely in older patients. Men ≥75 years of age were more than twice as likely to receive defibrillators and 65% more likely to undergo cardiac resynchronization than women. The primary composite outcome was nominally lower in women than men across all age groups. Vericiguat dosing did not differ between sexes in each age group, and its beneficial effect on the primary endpoint was not modified by age (continuous age, P = 0.169; categorical age, P = 0.189); and sex (3-way interaction; P = 0.847).
Although elderly women received less intense background HF therapy than men, their prognosis was nominally better. The benefit of vericiguat was independent of age and sex. (Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction [HFrEF] [MK-1242-001] [VICTORIA]; NCT02861534).
年龄和性别会影响心力衰竭（HF）患者的治疗及预后。
在对5050例射血分数降低的心力衰竭（HF）患者进行的VICTORIA（射血分数降低的心力衰竭患者的维立西呱全球研究）事后分析中，作者研究了年龄和性别与临床特征、背景治疗、预后以及维立西呱反应之间的关联；其中1568例（31%）年龄≥75岁，其中445例（24%）为女性。
比较不同年龄组（<65岁、65至<75岁、≥75岁）和性别的临床特征。使用Cox比例风险回归按年龄和性别估计维立西呱对主要复合结局（首次因心力衰竭住院或心血管死亡的时间）的治疗效果。
与年轻患者相比，≥75岁的患者有更多Ⅲ级和Ⅳ级症状、更高的N末端B型利钠肽原水平以及更差的肾功能，但三联疗法的使用最少。按年龄划分，三联疗法不存在性别差异，但老年患者达到三联疗法目标剂量的可能性较小。≥75岁的男性接受除颤器的可能性是女性的两倍多，接受心脏再同步治疗的可能性比女性高65%。在所有年龄组中，女性的主要复合结局名义上低于男性。各年龄组中维立西呱的给药剂量在性别上没有差异，其对主要终点的有益作用不受年龄（连续年龄；P = 0.169；分类年龄；P = 0.189）和性别的影响（三方交互作用；P = 0.847）。
尽管老年女性接受的背景性心力衰竭治疗强度低于男性，但其预后名义上更好。维立西呱的益处与年龄和性别无关。（射血分数降低的心力衰竭患者的维立西呱全球研究[HFrEF][MK - 1242 - 001][VICTORIA]；NCT02861534）
