Age-based analysis of the SEC-Excelente-HF registry: clinical characteristics and prognosis of a prospective cohort of heart failure patients.

Methods The SEC-Excelente-HF registry prospectively included 2,245 consecutive patients from 68 accredited HF units in Spain between 2019 and 2023. Patients were stratified by age (< 75 years, n = 1,267; ≥75 years, n = 973). Both hospitalized and outpatient HF patients were enrolled and followed for 1 year. Data included demographics, comorbidities, therapies, and devices. Primary outcomes were all-cause mortality, HF hospitalizations, and a composite of mortality or HF hospitalization. Multivariable Cox models identified independent predictors of outcomes in each age group. Results Median age was 73 years, and 43.4% were ≥ 75 years. Older patients had higher rates of atrial fibrillation (62% vs 45%), valvular heart disease (44.2% vs 28.8%), chronic kidney disease (51.2% vs 27.5%), and anemia (43.2% vs 24.4%; all p < 0.001). Guideline-directed therapies were less frequently used in older patients, including RAAS inhibitors (69.2% vs 81.1%), beta-blockers (73.8% vs 87.1%), MRAs (46.2% vs 70.5%), and SGLT2 inhibitors (42.0% vs 62.4%; all p < 0.001). At 1 year, event-free survival was 66.3% in older vs 77.0% in younger patients (log-rank p < 0.001). Independent predictors of the composite endpoint in older patients included prior HF, CRT/ICD implantation, anemia, malnutrition, functional disability, advanced CKD, and atrial fibrillation. Conclusions Older HF patients treated in accredited HF units present a higher comorbidity burden, lower use of evidence-based therapies, and worse clinical outcomes compared with younger counterparts. Optimizing multidisciplinary care is essential to improve survival and functional outcomes in elderly HF populations.