Age- and Sex-related Differences in Heart Failure Characteristics and Treatment Patterns Across the Ejection Fraction Spectrum: First Data from the BRING-UP-3 Heart Failure Study

Background: Older adults and females are under-represented in randomized clinical trials, and evidence on age- and sex-related differences in heart failure (HF) characteristics and treatment patterns is limited. Objectives: To evaluate age- and sex-related differences in clinical characteristics and treatments of an all-comers cohort of HF patients. Methods: The BRING-UP-3 HF study is a prospective, observational, multicenter investigation encompassing 179 Italian cardiology sites. Multivariable logistic regression models were applied to evaluate predictors of HF treatments across sex and age strata. Optimal medical therapy (OMT) was defined as the patient receiving all guideline-recommended medications. Results: A total of 5,203 HF patients (median age 72 years; 24% female) were included over three months. Females were older, had a higher prevalence of non-ischemic HF etiologies, and were less likely to receive OMT compared with males. Similarly, older patients also experienced suboptimal treatment. After multivariable adjustment only age remained independently associated with a lower likelihood of receiving OMT (odds ratio per five-year age increase 0.94, 95% confidence interval 0.88-0.93). Conclusions: Significant age- and sex-related disparities exist in HF characteristics and treatment patterns. Tailored management strategies are needed to optimize medical therapy for females and older adults, to improve HF outcomes and ensure equitable care. Trial registration number: NCT06279988.