{"paper_id":"36cb19c4-deae-426d-8a62-b468198d496d","body_text":"Age-based analysis of the SEC-Excelente-HF registry: clinical characteristics and prognosis of a prospective cohort of heart failure patients. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Age-based analysis of the SEC-Excelente-HF registry: clinical characteristics and prognosis of a prospective cohort of heart failure patients. Alberto Esteban-Fernández, Juan Luis Bonilla-Palomas, Javier Muñiz, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7952728/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract 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. Heart failure older patients SEC-Excelente prognosis multidisciplinary care Figures Figure 1 Figure 2 Key Summary Points Aim: To evaluate the clinical profile, management, and outcomes of elderly patients with heart failure (HF) treated in SEC-Excelente-accredited HF units in Spain, compared with younger patients. Findings: Older HF patients (≥ 75 years) had more comorbidities—including atrial fibrillation, valvular disease, kidney disease, and anemia—and received fewer guideline-directed therapies and device interventions. Their 1-year event-free survival was significantly lower than that of younger patients. Independent predictors of poor outcomes in older adults included anemia, malnutrition, functional disability, advanced chronic kidney disease, and atrial fibrillation. Message: Despite being managed in accredited HF units, elderly patients remain undertreated and experience worse outcomes. Targeted, multidisciplinary approaches are needed to improve prognosis and functional status in this vulnerable population. Introduction Heart failure (HF) is a major global health challenge due to its increasing incidence, particularly among older adults. Although advances in therapy have significantly reduced mortality, the prevalence of HF continues to rise, and it remains the leading cause of hospitalization in patients over 75 years in Spain 1,2 . Despite the growing proportion of elderly patients with HF, most clinical trials have systematically excluded older individuals, forcing clinicians to extrapolate data from younger populations. However, it is well established that older patients with HF present greater clinical complexity, characterized by a higher burden of comorbidities, geriatric syndromes, and social vulnerabilities, which complicate management and care 3 . Clinical practice guidelines strongly recommend the inclusion of HF patients in structured follow-up programs led by multidisciplinary teams, including nursing support, patient education, pathways for managing decompensations, and optimization of pharmacological treatment and devices. These programs have been demonstrated to reduce hospitalizations and mortality, while also improving quality of life. Notably, even frail patients can derive substantial benefit from structured, multidisciplinary follow-up. Particularly critical is the early post-discharge period , often referred to as the vulnerable phase , during which patients are at high risk of rehospitalization and death. Providing comprehensive transitional care and close follow-up during this phase has a significant impact on outcomes. In this context, multidisciplinary structured HF units can play a key role by ensuring early contact, timely optimization of therapy, and coordinated support after hospital discharge and during the follow-up 4–6 . In Spain, the SEC-Excelente accreditation program was developed to ensure high-quality, standardized follow-up for patients with HF. This program has demonstrated favorable results, with an increasing number of certified units nationwide 7,8 . However, data on the management and outcomes of older patients within these accredited HF units remain limited. This study aims to evaluate the clinical characteristics, management strategies, and outcomes of elderly patients with HF followed in hospitals with units accredited by the SEC-Excelente program in Spain. Materials and Methods The SEC-Excelente-HF program’s design, logistics, and unit classifications were previously reported 8 . Community units are typically located in primary hospitals that lack a cardiology department or on-site catheterization/electrophysiology capabilities. Specialized and advanced units are based in secondary or tertiary hospitals and embedded within cardiology departments. Advanced units are distinguished from specialized ones by the availability of on-site heart transplant programs and long-term mechanical circulatory support devices 8 . The scientific committee of the SEC-Excelente-HF program designed a registry project with a 1-year follow-up, requiring each accredited unit to enroll consecutive patients with HF managed in the unit during two specific 1-month periods (March and November) within a single year. Both the accreditation of units and their incorporation into the registry developed over time. The study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Clinical Research Ethics Committee of Hospital Central de Asturias. All participants provided written informed consent. The present analysis includes data from 68 accredited HF units, including patients who have completed a 1-year follow-up. Each participating center enrolled consecutive patients with HF managed in their unit during two separate months between 2019 and 2023. A total of 2,245 patients were included (Figure 1). Both hospitalized patients and outpatients with a recent hospital admission (within the previous 3 months) were eligible for inclusion. The analysis is based on age differences (<75 years and ≥ 75 years). At the 1-year follow-up visit after enrollment, data were collected on clinical outcomes—including deaths, HF hospitalizations, and HF decompensations (with or without hospital admission). Patients were followed until death or, otherwise, for 1 year from the date of inclusion. Decompensation without hospital admission was defined as a visit to the emergency department or HF day hospital due to clinical worsening of HF that, in the opinion of the treating physician, required an increase in diuretic dosage or intravenous therapy with diuretics or inotropic agents, but did not result in hospital admission. Patient follow-up and management were conducted according to the criteria established by the treating cardiologists, with no prespecified interventions outlined in the registry protocol. Statistical analysis Categorical variables were presented as frequencies and percentages, and quantitative variables as means with standard deviations or medians with interquartile ranges, as appropriate. Differences between age groups were assessed using the Chi-square or Fisher’s exact test for categorical variables, and the Mann–Whitney U test for quantitative variables. The 1-year cumulative incidence of the composite endpoint of all-cause mortality or HF decompensation was analyzed by age group. HF decompensation included hospitalizations and episodes managed without admission in the emergency department or day hospital. All recurrent events were considered in the analyses of hospitalizations and decompensations. Survival analyses were performed using the Kaplan–Meier method for the composite endpoint, and survival distributions were compared using the log-rank test. The association between age (analyzed as a continuous variable) and the composite endpoint was assessed using a multivariable Cox proportional hazards model. Variables considered for inclusion in the initial model were selected based on clinical relevance or statistical significance, incorporating those with a p-value <0.10 in univariable analyses and excluding variables with more than 10% missing data. The final model was obtained through backward elimination, retaining covariates with a p-value <0.05. To further explore age-related effects, an additional multivariable Cox model was conducted stratified by age group. Statistical significance was defined as a two-sided p-value <0.05 for all analyses. All statistical analyses were performed using SPSS® software, version 20.0 (IBM Corp., Armonk, NY, USA). Results Characteristics of Included Patients The median age was 73 years [63–80], with 973 patients (43.4%) aged ≥75 years. Most patients were male and presented a high prevalence of cardiovascular (CV) risk factors. Older patients more frequently had atrial fibrillation, chronic kidney disease, valvular heart disease, and left bundle branch block (Table 2). Non-CV comorbidities such as cancer and anemia, as well as geriatric syndromes—particularly malnutrition and dementia—were also more prevalent among older patients (Table 1). Elderly patients with HF showed a more advanced functional class (NYHA III: 47.6% vs 39.0%; p < 0.001), higher natriuretic peptide levels (2636 vs 1500 pg/mL; p < 0.001), and a greater prevalence of HFpEF (43.8% vs 21.9%; p < 0.001) compared with younger ones (Table 2). Regarding medical therapy, older patients were less frequently treated with drugs providing prognostic benefit, but more often received diuretics. They were also less likely to receive ICD or CRT therapies (Table 3). Referral rates to HF management programs were similar between groups (79.7% vs 76.8%; p = 0.093), although participation in cardiac rehabilitation was significantly lower among older patients (4.9% vs 13.6%; p < 0.001) (Table 3). Incidence of Events at 1-Year Follow-up During follow-up, 676 hospitalizations for HF occurred in 412 different patients (18.4%). The mean number of HF admissions per patient was 0.30 ± 0.99 in those <75 years and 0.30 ± 0.78 in those ≥75 years. Among patients with at least one HF hospitalization, the mean number of admissions was 1.64 ± 1.51 in the younger group and 1.46 ± 1.12 in the older group. Differences in the composite endpoint (all-cause mortality or HF hospitalization) between patients <75 and ≥75 years are depicted in the Kaplan–Meier survival curves (Figure 2). Older patients showed a significantly higher incidence of the composite outcome during follow-up (log-rank test, p < 0.001). Event-free survival decreased from 95.7% at 1 month to 66.3% at 1 year in older patients, and from 97.4% to 77.0% in younger ones (Table 4). Age-Related Predictors of Mortality and Heart Failure Hospitalization After adjustment for advanced renal failure, inclusion from hospital, previous HF, ischemic HF, NYHA III/IV, prior CRT/ICD implantation, previous valvular heart disease, previous atrial fibrillation, hemiplegia/paraplegia/functional disability, anemia, and malnutrition, each 10-year increase in age was associated with a 10.4% higher risk of mortality or HF hospitalization (crude HR: 1.30 [1.21-1,39; p < 0.001] and adjusted HR: 1.10 [1.02-1.20; p = 0.015] (Supplementary Table 1). In older patients, the main predictors of mortality or HF hospitalization were prior CRT/ICD implantation, previous HF, anemia, malnutrition, and functional disability. In younger patients, functional disability, previous HF, malnutrition, and advanced chronic kidney disease were identified as independent predictors of the composite event (Table 5) Discussion In this national registry of patients managed in SEC-Excelente-accredited HF units, older adults had a higher burden of comorbidities, received fewer guideline-directed therapies and device interventions, and showed worse one-year outcomes than younger patients. These findings underscore the ongoing need for comprehensive, multidisciplinary care to improve prognosis in older HF patients. HF is a highly prevalent condition in clinical practice, with the majority of patients being older than 75 years 9 . A higher burden of comorbidities characterizes this aging patient profile. In another study based on administrative data of elderly patients in Spain, the most common comorbidities were renal failure, diabetes, and valvular disease 3 —findings consistent with the characteristics of the population included in the SEC-Excelente registry. The presence of CV comorbidities plays a key role in determining prognosis. Conditions such as arrhythmias, ischemic cardiomyopathy, chronic kidney disease, and valvular disorders have been identified as predictors of both short- and long-term readmissions 1,10 . In our study, we observed a higher prevalence of atrial fibrillation, as well as valvular and ischemic heart diseases, which were also associated with an increased risk of mortality and HF-related readmission. These findings underscore the need for cardiology involvement and a multidisciplinary approach to optimize outcomes in older patients, who are often underrepresented in follow-up due to comorbidities. Interestingly, a high prevalence of non-CV comorbidities and geriatric syndromes was also observed. These conditions further complicate patient management and underscore the need for a multidisciplinary approach to care 11 . Consistent with our findings, previous studies have also identified dementia, malnutrition, and functional disability as predictors of short-term mortality following hospital discharge for HF 1,12,13 . For this reason, patients monitored in HF units within cardiology departments should involve professionals from other specialties to manage comorbidities adequately. Correcting iron deficiency has been shown to improve function and reduce hospital admissions in patients with HF 14 . Concerning malnutrition, although there is evidence in the acute setting, proof in the outpatient setting is limited. Ongoing studies, such as BOCADOS-IC, will shed more light on this issue 15,16 . Age itself is a non-modifiable factor that increases the risk of readmission and mortality among patients with HF, as confirmed in our study. Previous analyses based on administrative data in elderly patients focused mainly on in-hospital mortality after readmission, rather than long-term outcomes. Our findings, together with other studies, suggest that among older adults, comorbidities, frailty, and clinical management strategies exert a more decisive influence on prognosis than chronological age alone 10 . Notably, the prevalence of advanced renal dysfunction was very high and has consistently been identified as a marker of poor prognosis 1,3 . Recent studies, however, have shown that advanced renal dysfunction is not independently associated with one-year mortality after adjusting for frailty, underscoring the complex interplay between comorbidities, frailty, and outcomes in patients with HF 17 . The proportion of patients receiving therapies with proven prognostic benefit 18 , even among those with HFrEF, remains extremely low. Although the higher prevalence of chronic kidney disease, atrial fibrillation, symptomatic hypotension, and hyperkalemia in older patients can limit the implementation of guideline-directed medical therapy, these factors alone do not fully explain the approximately 20% difference in the use of quadruple therapy between older and younger patients, despite its proven prognostic benefit. Of particular concern is the low prescription rate of SGLT2 (sodium-glucose cotransporter 2) inhibitors, which are indicated across the spectrum of HF 19 , with only 42% of older patients in our cohort being treated with them. Optimizing the management of comorbidities in older HF patients is not sufficient—it is also essential to implement therapies that have been shown to modify the natural course of the disease. In patients with non-reversible frailty, it may be reasonable to withhold therapies with prognostic benefit, as frailty may have a greater impact on outcomes than HF itself. Device therapy is also underutilized in older patients. The implantation of an ICD, particularly in robust patients with ischemic cardiomyopathy, should be considered in all eligible cases. Likewise, CRT represents an essential intervention for symptom relief and prognosis improvement, with well-established benefits even in older individuals. This is especially relevant given that approximately 25% of patients present with left bundle branch block and may derive significant benefit from CRT. Once again, older patients are frequently excluded from receiving therapies with proven prognostic benefit based solely on age 20–22 . Similarly, the low participation in cardiac rehabilitation programs is concerning, as these interventions have been shown to improve functional capacity, cognitive function, and prognosis, particularly in older adults with frailty or at risk of frailty 23,24 . The implementation of guideline-directed therapies and multidisciplinary management of comorbidities may help mitigate the substantial prognostic differences observed in our study. These differences include a 3.2% higher monthly mortality and a 10.7% higher annual mortality, which cannot be explained by age alone. Inclusion of older patients in structured HF programs, similar to younger patients, likely contributes to reducing these differences 4 . The under-treatment may be driven by therapeutic inertia related to age or concerns about a higher risk of adverse events; the latter is less relevant in robust older patients but may influence decisions in frail individuals. Early post-decompensation care, even in frail patients, has been shown to reduce adverse events. In a recent study using administrative data, although fewer than 3% of patients were referred to social or healthcare centers after HF hospitalization, those who were referred experienced better outcomes than those discharged home 5 . This is likely due to improved continuity of care, which directly impacts prognosis 6,25,26 . These findings underscore that all HF patients should be included in structured, multidisciplinary care programs that provide resources tailored to each phase of patient management. In this context, the SEC-Excelente accreditation program has facilitated the implementation of several quality criteria essential for the optimal care of these patients in our setting 8 . Our study has several limitations. First, it does not represent the entire population of Spain, not even within cardiology services; however, the large sample size allows us to derive meaningful results from routine clinical practice. In addition, the inclusion of numerous centers distributed throughout Spain enhances the external validity of our findings. Second, the data were collected over different time points, which may explain the lower implementation rates of specific therapies due to evolving evidence. Nevertheless, this does not fully account for the differences observed by age. In conclusion, older patients with HF receive fewer therapies with proven prognostic benefit than younger patients, even when followed in accredited HF units. Mortality and HF decompensations are more frequent in this population, with both cardiovascular and non-cardiovascular comorbidities exerting a significant impact on outcomes. These findings highlight the need for a comprehensive, multidisciplinary approach to managing chronic HF in Spain, ensuring that older patients receive optimal care tailored to their disease stage and the presence of geriatric syndromes. Abbreviations CV: cardiovascular HF: heart failure HFpEF: heart failure with preserved ejection fraction HFmrEF: heart failure with mildly reduced ejection fraction HFrEF: heart failure with reduced ejection fraction SEC: Spanish Society of Cardiology Declarations Sources of funding This work does not receive any external funding. R. Gonzalez-Manzanares holds a Juan Rodés research contract (JR24/00064; Instituto de Salud Carlos III, Madrid, Spain). This registry is supported by an unconditional grant from ROVI Laboratories. Conflicts of interest There are no conflicts of interest for this work. Authors' contributions Study design: AEF, JLBP, JM, MAS. Manuscript preparation: AEF, JM. Manuscript review, editing, and acceptance: all authors. 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Rev Esp Cardiol (Engl Ed) . 2016;69(10):951-961. Tables Table 1. Characteristics of patients included according to age Characteristics <75 years N=1,267 ≥75 years N=973 p Type of inclusion-n (%) <0.001 Hospitalized 753 (59.4) 737 (75.6) Outpatient 514 (40.6) 236 (24.3) Previous follow-up in HF unit 495/1267 (39.1) 284/972 (29.2) <0.001 Type of HF unit -n (%) 0.024 Community 213 (16.8) 194 (19.9) Specialized 850 (67.1) 656 (67.4) Advanced 204 (16.1) 123 (12.6) Sex (male) 915 (72.2) 527 (54.2) <0.001 Previous HF-n (%) <0.001 LVEF <40% 817/1221 (66.9) 397/941 (42.2) LVEF 41-49% 137/1221 (11.2) 132/941 (14.0) LVEF >50% 267/1221 (21.9) 412/941(43.8) HF diagnosis-n (%) 0.04 New diagnosis 535 (42.2) 369 (37.9) Chronic HF 732 (57.8) 604 (62.1) HF hospitalizations in the previous year 411 (32.4) 305 (31.4) 0.583 HF etiology-n (%) <0.001 Ischemic 414 (32.8) 281 (28.9) Valvular heart disease 128 (10.1) 219 (22.5) Dilated cardiomyopathy 237 (18.8) 95 (9.8) Arrythmia 174 (13.8) 152 (15.6) Hypertensive 68 (5.4) 106 (10.9) CV risk factors-n (%) Arterial hypertension 803/1266 (63.4) 825/972 (84.9) <0.001 Diabetes 536/1266 (42.3) 454/971 (46.8) 0.037 Current smoker 289/1266 (22.8) 50/972 (5.1) <0.001 CV comorbidities-n (%) Acute coronary syndrome 383 (30.2) 289 (29.7) 0.787 Coronary intervention 0.136 Percutaneous 326 (25.7) 220 (22.6) Coronary artery bypass grafting 61 (4.8) 43 (4.4) Hybrid 22 (1.7) 27 (2.8) Valvular heart disease 365/1266 (28.8) 430/973 (44.2) <0.001 Atrial fibrillation <0.001 Paroxysmal 187 (14.8) 161 (16.6) Persistent 159 (12.6) 91 (9.4) Permanent 228 (18.0) 347 (35.7) Non-CV comorbidities-n (%) Chronic kidney disease 348/1265 (27.5) 497/971 (51.2) <0.001 Stroke 122/1266 (9.6) 104/971 (10.7) 0.404 COPD 202/1266 (16.0) 162/972 (16.7) 0.651 OSA with CPAP 175/1266 (13.8) 95/972 (9.8) 0.004 Dementia 23/1266 (1.82) 56/972 (5.8) <0.001 Hemiplegia, paraplegia and functional disability 32/1265 (2.5) 37/972 (3.8) 0.083 Active cancer/lymphoma/leukemia 67/1266 (5.3) 79/972 (8.1) 0.007 Trauma or falls in the last year 44/1266 (3.5) 48/972 (4.9) 0.084 Anemia 309/1266 (24.4) 419/971 (43.2) <0,001 Iron deficiency 360/1260 (28.6) 398/968 (41.1) <0,001 Significant hyponatremia 40/1265 (3.2) 32/972 (3.3) 0.863 Malnutrition 42/1266 (3.3) 53/972 (5.5) 0.013 COPD: chronic obstructive pulmonary disease; CPAP: continuous positive airway pressure; CV: cardiovascular; HF: heart failure; LVEF: left ventricular ejection fraction; OSA: obstructive sleep apnea. Table 2. Clinical and analytical parameters of patients included according to age Characteristics <75 years N=1,267 ≥75 years N=973 p Functional class-n (%) <0.001 NYHA I 165 (13.1) 34 (3.5) NYHA II 473 (37.6) 339 (35.1) NYHA III 491 (39.0) 460 (47.6) NYHA IV 130 (10.3) 133 (13.8) HF categories-n (%) <0.001 HFrEF 817 (66.9) 397 (42.2) HFmrEF 137 (11.2) 132 (14.0) HFpEF 267 (21.9) 412 (43.8) Clinical parameters BMI (kg/m 2 ) 28.0 (24.7;32.0) 26.6 (24.7; 32,0) <0.001 SBP (mmHg) 112 (100;125) 118 (105;130) <0.001 HR (bpm) 70 (62;80) 70 (62;80) 0,957 Left bundle branch block-n (%) 259/1264 (20.5) 241/973 (24.8) 0.016 LVEF (%) 35 (26-45) 45 (32-58) <0.001 Blood parameters Hb (g/dL) 13.8 (12.0;15.2) 12.5 (11.0-14.0) <0.001 Na (mEq/L) 139 (137;141) 139 (137;141) 0.332 K (mEq/L) 4.3 (4.0;4.7) 4.2 (3.9;4.7) 0.014 GFR (mL/min) 68 (52;87) 49 (35;66) <0.001 GFR<30 mL/min-n (%) 80/1165 (6.9) 144/918 (15.7) <0.001 NTproBNP (pg/mL) 1500 (648;3557) 2636 (1227;5716) <0.001 BMI: body mass index; BPM: beats per minute; CV: cardiovascular; GFR: glomerular filtration rate; Hb: hemoglobin; HF: heart failure; HFmrEF: heart failure with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction; HR: heart rate; K: potassium; LVEF: left ventricular ejection fraction; Na: sodium; NYHA: New York Heart Association; SBP: systolic blood pressure. Table 3. Pharmacological treatment, devices, and outpatient programs based on age Characteristics <75 years N=1,267 ≥75 years N=973 p ACEi/ARB/SV-n (%) 1025/1264 (81.1) 673/972 (69.2) <0.001 ACEi/ARB/SV in LVEF<40%-n (%) 715/815 (87.7) 315/397 (79.4) <0.001 BB-n (%) 1099/1262 (87.1) 717/972 (73.8) <0.001 BB in LVEF<40%-n (%) 751/813 (92.4) 329/397 (82.9) <0.001 MRA-n (%) 891/1264 (70.5) 449/972 (46.2) <0.001 MRA in LVEF<40%-n (%) 663/815 (81.4) 257/397 (64.7) <0.001 SGLT2i-n (%) 788/1263 (62.4) 408/971 (42.0) <0.001 SGLT2i in LVEF<40%-n (%) 568/815 (69.7) 222/397 (55.9) <0.001 Quadruple therapy-n (%) 552/1261 (43.8) 193/971 (19.9) <0.001 Quadruple therapy in LVEF<40%-n (%) 438/813 (53.9) 142/397 (35.8) <0.001 Diuretics-n (%) 968/1264 (76.6) 847/971 (87.2) <0.001 Digoxin-n (%) 104/1263 (8.2) 68/971 (7.0) 0.279 K-binders-n (%) 33/1263 (2.6) 20/971 (2.1) 0.394 Antiplatelet agents-n (%) 425/1263 (33.7) 308/971 (31.7) 0.335 Direct oral anticoagulants-n (%) 437 (34.6) 439 (45.2) <0.001 Anti-vitamin K anticoagulants-n (%) 231 (18.3) 176 (18.1) <0.001 Electronic device-n (%) <0.001 CRT 16 (1.3) 29 (3.0) ICD 139 (11.0) 38 (3.9) CRT-ICD 103 (8.1) 38 (3.9) Conventional pacemaker-n (%) 41 (3.2) 127 (13.1) HF program*-n (%) 1007/1263 (79.7) 744/969 (76.8) 0.093 Cardiac rehabilitation program-n (%) 172/1262 (13.6) 47/969 (4.9) <0.001 *Follow-up plan established with multidisciplinary team, including nursing and primary care ACEi: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; BB: beta-blocker; CRT: cardiac resynchronization therapy; ICD: implantable cardioverter defibrillator; HF: heart failure; K: potassium; LVEF: left ventricular ejection fraction; MRA: mineralocorticoid receptor antagonist; SGLT2i: sodium-glucose cotransporter 2 inhibitor; SV: sacubitril-valsartan. Table 4. Incidence of the composite endpoint during follow-up according to age Time < 75 years ≥ 75 years P (%) 95% CI P (%) 95% CI 1 month 97.4 96.4 98.1 95.7 94.2 96.8 3 months 91.0 89.3 92.5 86.7 84.5 88.7 6 months 85.3 83.2 87.1 78.5 75.8 81.0 9 months 81.0 78.7 83.1 74.1 71.2 76.8 1 year 77.0 74.5 79.3 66.3 63.1 69.2 CI: confidence interval; P: percentage Table 5. Predictors of composite outcome based on age < 75 years N=1,154 ≥ 75 years N=906 HR (95% CI ) p HR (95% CI) p GFR < 30 mL/min 1.55 (1.07-2.26) 0.022 1.38 (1.04-1.83) 0.024 Hospital-based inclusion 1.73 (1.27-2.38) 0.001 1.85 (1.29-2.65) 0.001 Previous HF 1.73 (1.31-2.29) <0.001 1.57 (1.21-2.04) 0.001 Ischemic etiology of HF 1.38 (1.07-1.79) 0.014 1.34 (1.05-1.71) 0.019 Functional class NYHA III-IV 1.60 (1.20-2.13) 0.001 1.39 (1.05-1.84) 0.020 Previous TRC/ICD implant 1.50 (1.03-2.17) 0.032 1.69 (1.07-2.69) 0.025 Previous valvular heart disease 1.49 (1.16-1.93) 0.002 1.10 (0.87-1.39) 0.428 Previous atrial fibrillation 1.46 (1.13-1.87) 0.004 1.35 (1.05-1.75) 0.019 Hemiplegia, paraplegia, functional disability 1.92 (1.04-3.58) 0.039 1.52 (0.95-2.45) 0.080 Anemia 1.37 (1.05-1.78) 0.019 1.40 (1.11-1.78) 0.005 Malnutrition 1.71 (1.03-2.86) 0.040 1.53 (1.03-2.26) 0.035 CI: confidence interval; CRT: cardiac resynchronization therapy; GFR: glomerular filtration rate; HF: heart failure; HR: hazard ratio; ICD: for implantable cardioverter defibrillator; NYHA: New York Heart Association. Supplementary Files Supplementarymaterial.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revisions 10 Dec, 2025 Reviewers agreed at journal 04 Dec, 2025 Reviewers invited by journal 11 Nov, 2025 Editor invited by journal 04 Nov, 2025 Editor assigned by journal 29 Oct, 2025 First submitted to journal 26 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7952728\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":543410118,\"identity\":\"544fd7ec-3207-420f-beac-27a074c04459\",\"order_by\":0,\"name\":\"Alberto 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09:13:59\",\"extension\":\"jpeg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":168747,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eFlow chart of patients included in the study\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7952728/v1/31e1fb9251ccc180f81de97d.jpeg\"},{\"id\":96493034,\"identity\":\"648f32b1-2c5f-4413-bf00-773664fac1e1\",\"added_by\":\"auto\",\"created_at\":\"2025-11-21 18:13:46\",\"extension\":\"jpeg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":269033,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eEvent-free survival curves according to age\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7952728/v1/9758bb9e4ff8f9ac6a79fc0f.jpeg\"},{\"id\":96709245,\"identity\":\"855ab178-548b-444a-aecf-3ab4a3738962\",\"added_by\":\"auto\",\"created_at\":\"2025-11-25 10:08:26\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1645691,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7952728/v1/10f0cefb-cf06-4045-a063-a1addcb7d233.pdf\"},{\"id\":96604051,\"identity\":\"1a55595e-06fe-4bd3-aa02-40dd662e4a72\",\"added_by\":\"auto\",\"created_at\":\"2025-11-24 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kidney disease, and anemia\\u0026mdash;and received fewer guideline-directed therapies and device interventions. Their 1-year event-free survival was significantly lower than that of younger patients. Independent predictors of poor outcomes in older adults included anemia, malnutrition, functional disability, advanced chronic kidney disease, and atrial fibrillation.\\u003c/p\\u003e\\u003cp\\u003eMessage: Despite being managed in accredited HF units, elderly patients remain undertreated and experience worse outcomes. Targeted, multidisciplinary approaches are needed to improve prognosis and functional status in this vulnerable population.\\u003c/p\\u003e\"},{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eHeart failure (HF) is a major global health challenge due to its increasing incidence, particularly among older adults. Although advances in therapy have significantly reduced mortality, the prevalence of HF continues to rise, and it remains the leading cause of hospitalization in patients over 75 years in Spain\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e1,2\\u003c/span\\u003e\\u003c/sup\\u003e. Despite the growing proportion of elderly patients with HF, most clinical trials have systematically excluded older individuals, forcing clinicians to extrapolate data from younger populations. However, it is well established that older patients with HF present greater clinical complexity, characterized by a higher burden of comorbidities, geriatric syndromes, and social vulnerabilities, which complicate management and care\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e3\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eClinical practice guidelines strongly recommend the inclusion of HF patients in structured follow-up programs led by multidisciplinary teams, including nursing support, patient education, pathways for managing decompensations, and optimization of pharmacological treatment and devices. These programs have been demonstrated to reduce hospitalizations and mortality, while also improving quality of life. Notably, even frail patients can derive substantial benefit from structured, multidisciplinary follow-up. Particularly critical is the\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003eearly post-discharge period\\u003c/strong\\u003e\\u003cstrong\\u003e,\\u0026nbsp;\\u003c/strong\\u003eoften referred to as the\\u0026nbsp;\\u003cem\\u003evulnerable phase\\u003c/em\\u003e, during which patients are at high risk of rehospitalization and death. Providing comprehensive transitional care and close follow-up during this phase has a significant impact on outcomes. In this context, multidisciplinary structured HF units can play a key role by ensuring early contact, timely optimization of therapy, and coordinated support after hospital discharge and during the follow-up\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e4\\u0026ndash;6\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eIn Spain, the\\u0026nbsp;\\u003cstrong\\u003eSEC-Excelente\\u003c/strong\\u003e accreditation program was developed to ensure high-quality, standardized follow-up for patients with HF. This program has demonstrated favorable results, with an increasing number of certified units nationwide\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e7,8\\u003c/span\\u003e\\u003c/sup\\u003e. However, data on the management and outcomes of older patients within these accredited HF units remain limited. This study aims to evaluate the clinical characteristics, management strategies, and outcomes of elderly patients with HF followed in hospitals with units accredited by the\\u0026nbsp;\\u003cstrong\\u003eSEC-Excelente\\u003c/strong\\u003e program in Spain.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cp\\u003eThe SEC-Excelente-HF program\\u0026rsquo;s design, logistics, and unit classifications were previously reported\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e8\\u003c/span\\u003e\\u003c/sup\\u003e. Community units are typically located in primary hospitals that lack a cardiology department or on-site catheterization/electrophysiology capabilities. Specialized and advanced units are based in secondary or tertiary hospitals and embedded within cardiology departments. Advanced units are distinguished from specialized ones by the availability of on-site heart transplant programs and long-term mechanical circulatory support devices\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e8\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eThe scientific committee of the SEC-Excelente-HF program designed a registry project with a 1-year follow-up, requiring each accredited unit to enroll consecutive patients with HF managed in the unit during two specific 1-month periods (March and November) within a single year. Both the accreditation of units and their incorporation into the registry developed over time. The study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Clinical Research Ethics Committee of Hospital Central de Asturias. All participants provided written informed consent.\\u003c/p\\u003e\\n\\u003cp\\u003eThe present analysis includes data from 68 accredited HF units, including patients who have completed a 1-year follow-up. Each participating center enrolled consecutive patients with HF managed in their unit during two separate months between 2019 and 2023. A total of 2,245 patients were included (Figure 1). Both hospitalized patients and outpatients with a recent hospital admission (within the previous 3 months) were eligible for inclusion. The analysis is based on age differences (\\u0026lt;75 years and\\u0026nbsp;\\u0026ge;\\u0026nbsp;75 years).\\u003c/p\\u003e\\n\\u003cp\\u003eAt the 1-year follow-up visit after enrollment, data were collected on clinical outcomes\\u0026mdash;including deaths, HF hospitalizations, and HF decompensations (with or without hospital admission). Patients were followed until death or, otherwise, for 1 year from the date of inclusion. Decompensation without hospital admission was defined as a visit to the emergency department or HF day hospital due to clinical worsening of HF that, in the opinion of the treating physician, required an increase in diuretic dosage or intravenous therapy with diuretics or inotropic agents, but did not result in hospital admission. Patient follow-up and management were conducted according to the criteria established by the treating cardiologists, with no prespecified interventions outlined in the registry protocol.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cu\\u003eStatistical analysis\\u003c/u\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCategorical variables were presented as frequencies and percentages, and quantitative variables as means with standard deviations or medians with interquartile ranges, as appropriate. Differences between age groups were assessed using the Chi-square or Fisher\\u0026rsquo;s exact test for categorical variables, and the Mann\\u0026ndash;Whitney U test for quantitative variables.\\u003c/p\\u003e\\n\\u003cp\\u003eThe 1-year cumulative incidence of the composite endpoint of all-cause mortality or HF decompensation was analyzed by age group. HF decompensation included hospitalizations and episodes managed without admission in the emergency department or day hospital. All recurrent events were considered in the analyses of hospitalizations and decompensations. Survival analyses were performed using the Kaplan\\u0026ndash;Meier method for the composite endpoint, and survival distributions were compared using the log-rank test.\\u003c/p\\u003e\\n\\u003cp\\u003eThe association between age (analyzed as a continuous variable) and the composite endpoint was assessed using a multivariable Cox proportional hazards model. Variables considered for inclusion in the initial model were selected based on clinical relevance or statistical significance, incorporating those with a p-value \\u0026lt;0.10 in univariable analyses and excluding variables with more than 10% missing data. The final model was obtained through backward elimination, retaining covariates with a p-value \\u0026lt;0.05. To further explore age-related effects, an additional multivariable Cox model was conducted stratified by age group.\\u003c/p\\u003e\\n\\u003cp\\u003eStatistical significance was defined as a two-sided p-value \\u0026lt;0.05 for all analyses. All statistical analyses were performed using SPSS\\u0026reg; software, version 20.0 (IBM Corp., Armonk, NY, USA).\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cu\\u003eCharacteristics of Included Patients\\u003c/u\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe median age was 73 years [63\\u0026ndash;80], with 973 patients (43.4%) aged \\u0026ge;75 years. Most patients were male and presented a high prevalence of cardiovascular (CV) risk factors. Older patients more frequently had atrial fibrillation, chronic kidney disease, valvular heart disease, and left bundle branch block (Table 2). Non-CV comorbidities such as cancer and anemia, as well as geriatric syndromes\\u0026mdash;particularly malnutrition and dementia\\u0026mdash;were also more prevalent among older patients (Table 1). Elderly patients with HF showed a more advanced functional class (NYHA III: 47.6% vs 39.0%; p \\u0026lt; 0.001), higher natriuretic peptide levels (2636 vs 1500 pg/mL; p \\u0026lt; 0.001), and a greater prevalence of HFpEF (43.8% vs 21.9%; p \\u0026lt; 0.001) compared with younger ones (Table 2).\\u003c/p\\u003e\\n\\u003cp\\u003eRegarding medical therapy, older patients were less frequently treated with drugs providing prognostic benefit, but more often received diuretics. They were also less likely to receive ICD or CRT therapies (Table 3). Referral rates to HF management programs were similar between groups (79.7% vs 76.8%; p = 0.093), although participation in cardiac rehabilitation was significantly lower among older patients (4.9% vs 13.6%; p \\u0026lt; 0.001) (Table 3).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cu\\u003eIncidence of Events at 1-Year Follow-up\\u003c/u\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDuring follow-up, 676 hospitalizations for HF occurred in 412 different patients (18.4%).\\u003cbr\\u003e\\u0026nbsp;The mean number of HF admissions per patient was 0.30 \\u0026plusmn; 0.99 in those \\u0026lt;75 years and 0.30 \\u0026plusmn; 0.78 in those \\u0026ge;75 years. Among patients with at least one HF hospitalization, the mean number of admissions was 1.64 \\u0026plusmn; 1.51 in the younger group and 1.46 \\u0026plusmn; 1.12 in the older group.\\u003c/p\\u003e\\n\\u003cp\\u003eDifferences in the composite endpoint (all-cause mortality or HF hospitalization) between patients \\u0026lt;75 and \\u0026ge;75 years are depicted in the Kaplan\\u0026ndash;Meier survival curves (Figure 2).\\u003cbr\\u003e\\u0026nbsp;Older patients showed a significantly higher incidence of the composite outcome during follow-up (log-rank test, p \\u0026lt; 0.001). Event-free survival decreased from 95.7% at 1 month to 66.3% at 1 year in older patients, and from 97.4% to 77.0% in younger ones (Table 4).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cu\\u003eAge-Related Predictors of Mortality and Heart Failure Hospitalization\\u003c/u\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAfter adjustment for advanced renal failure, inclusion from hospital, previous HF, ischemic HF, NYHA III/IV, prior CRT/ICD implantation, previous valvular heart disease, previous atrial fibrillation, hemiplegia/paraplegia/functional disability, anemia, and malnutrition, each 10-year increase in age was associated with a 10.4% higher risk of mortality or HF hospitalization (crude HR: 1.30 [1.21-1,39; p \\u0026lt; 0.001] and adjusted HR: 1.10 [1.02-1.20; p = 0.015] (Supplementary Table 1).\\u003c/p\\u003e\\n\\u003cp\\u003eIn older patients, the main predictors of mortality or HF hospitalization were prior CRT/ICD implantation, previous HF, anemia, malnutrition, and functional disability.\\u003cbr\\u003e\\u0026nbsp;In younger patients, functional disability, previous HF, malnutrition, and advanced chronic kidney disease were identified as independent predictors of the composite event (Table 5)\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this national registry of patients managed in SEC-Excelente-accredited HF units, older adults had a higher burden of comorbidities, received fewer guideline-directed therapies and device interventions, and showed worse one-year outcomes than younger patients. These findings underscore the ongoing need for comprehensive, multidisciplinary care to improve prognosis in older HF patients.\\u003c/p\\u003e\\n\\u003cp\\u003eHF is a highly prevalent condition in clinical practice, with the majority of patients being older than 75 years\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e9\\u003c/span\\u003e\\u003c/sup\\u003e. A higher burden of comorbidities characterizes this aging patient profile. In another study based on administrative data of elderly patients in Spain, the most common comorbidities were renal failure, diabetes, and valvular disease\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e3\\u003c/span\\u003e\\u003c/sup\\u003e\\u0026mdash;findings consistent with the characteristics of the population included in the SEC-Excelente registry.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe presence of CV comorbidities plays a key role in determining prognosis. Conditions such as arrhythmias, ischemic cardiomyopathy, chronic kidney disease, and valvular disorders have been identified as predictors of both short- and long-term readmissions\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e1,10\\u003c/span\\u003e\\u003c/sup\\u003e. In our study, we observed a higher prevalence of atrial fibrillation, as well as valvular and ischemic heart diseases, which were also associated with an increased risk of mortality and HF-related readmission. These findings underscore the need for cardiology involvement and a multidisciplinary approach to optimize outcomes in older patients, who are often underrepresented in follow-up due to comorbidities.\\u003c/p\\u003e\\n\\u003cp\\u003eInterestingly, a high prevalence of non-CV comorbidities and geriatric syndromes was also observed. These conditions further complicate patient management and underscore the need for a multidisciplinary approach to care\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e11\\u003c/span\\u003e\\u003c/sup\\u003e. Consistent with our findings, previous studies have also identified dementia, malnutrition, and functional disability as predictors of short-term mortality following hospital discharge for HF\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e1,12,13\\u003c/span\\u003e\\u003c/sup\\u003e. For this reason, patients monitored in HF units within cardiology departments should involve professionals from other specialties to manage comorbidities adequately. Correcting iron deficiency has been shown to improve function and reduce hospital admissions in patients with HF\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e14\\u003c/span\\u003e\\u003c/sup\\u003e. Concerning malnutrition, although there is evidence in the acute setting, proof in the outpatient setting is limited. Ongoing studies, such as BOCADOS-IC, will shed more light on this issue\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e15,16\\u003c/span\\u003e\\u003c/sup\\u003e.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAge itself is a non-modifiable factor that increases the risk of readmission and mortality among patients with HF, as confirmed in our study. Previous analyses based on administrative data in elderly patients focused mainly on in-hospital mortality after readmission, rather than long-term outcomes. Our findings, together with other studies, suggest that among older adults, comorbidities, frailty, and clinical management strategies exert a more decisive influence on prognosis than chronological age alone\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e10\\u003c/span\\u003e\\u003c/sup\\u003e. Notably, the prevalence of advanced renal dysfunction was very high and has consistently been identified as a marker of poor prognosis\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e1,3\\u003c/span\\u003e\\u003c/sup\\u003e. Recent studies, however, have shown that advanced renal dysfunction is not independently associated with one-year mortality after adjusting for frailty, underscoring the complex interplay between comorbidities, frailty, and outcomes in patients with HF\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e17\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eThe proportion of patients receiving therapies with proven prognostic benefit\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e18\\u003c/span\\u003e\\u003c/sup\\u003e, even among those with HFrEF, remains extremely low. Although the higher prevalence of chronic kidney disease, atrial fibrillation, symptomatic hypotension, and hyperkalemia in older patients can limit the implementation of guideline-directed medical therapy, these factors alone do not fully explain the approximately 20% difference in the use of quadruple therapy between older and younger patients, despite its proven prognostic benefit. Of particular concern is the low prescription rate of SGLT2 (sodium-glucose cotransporter 2) inhibitors, which are indicated across the spectrum of HF\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e19\\u003c/span\\u003e\\u003c/sup\\u003e, with only 42% of older patients in our cohort being treated with them. Optimizing the management of comorbidities in older HF patients is not sufficient\\u0026mdash;it is also essential to implement therapies that have been shown to modify the natural course of the disease. In patients with non-reversible frailty, it may be reasonable to withhold therapies with prognostic benefit, as frailty may have a greater impact on outcomes than HF itself.\\u003c/p\\u003e\\n\\u003cp\\u003eDevice therapy is also underutilized in older patients. The implantation of an ICD, particularly in robust patients with ischemic cardiomyopathy, should be considered in all eligible cases. Likewise, CRT represents an essential intervention for symptom relief and prognosis improvement, with well-established benefits even in older individuals. This is especially relevant given that approximately 25% of patients present with left bundle branch block and may derive significant benefit from CRT. Once again, older patients are frequently excluded from receiving therapies with proven prognostic benefit based solely on age\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e20\\u0026ndash;22\\u003c/span\\u003e\\u003c/sup\\u003e. Similarly, the low participation in cardiac rehabilitation programs is concerning, as these interventions have been shown to improve functional capacity, cognitive function, and prognosis, particularly in older adults with frailty or at risk of frailty\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e23,24\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eThe implementation of guideline-directed therapies and multidisciplinary management of comorbidities may help mitigate the substantial prognostic differences observed in our study. These differences include a 3.2% higher monthly mortality and a 10.7% higher annual mortality, which cannot be explained by age alone. Inclusion of older patients in structured HF programs, similar to younger patients, likely contributes to reducing these\\u0026nbsp;differences\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e4\\u003c/span\\u003e\\u003c/sup\\u003e. The under-treatment may be driven by therapeutic inertia related to age or concerns about a higher risk of adverse events; the latter is less relevant in robust older patients but may influence decisions in frail individuals. Early post-decompensation care, even in frail patients, has been shown to reduce adverse events. In a recent study using administrative data, although fewer than 3% of patients were referred to social or healthcare centers after HF hospitalization, those who were referred experienced better outcomes than those discharged\\u0026nbsp;home\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e5\\u003c/span\\u003e\\u003c/sup\\u003e.\\u0026nbsp;This is likely due to improved continuity of care, which directly impacts\\u0026nbsp;prognosis\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e6,25,26\\u003c/span\\u003e\\u003c/sup\\u003e.\\u0026nbsp;\\u0026nbsp;These findings underscore that all HF patients should be included in structured, multidisciplinary care programs that provide resources tailored to each phase of patient management. In this context, the SEC-Excelente accreditation program has facilitated the implementation of several quality criteria essential for the optimal care of these patients in our\\u0026nbsp;setting\\u003csup\\u003e\\u003cspan lang=\\\"EN-US\\\"\\u003e8\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eOur study has several limitations. First, it does not represent the entire population of Spain, not even within cardiology services; however, the large sample size allows us to derive meaningful results from routine clinical practice. In addition, the inclusion of numerous centers distributed throughout Spain enhances the external validity of our findings. Second, the data were collected over different time points, which may explain the lower implementation rates of specific therapies due to evolving evidence. Nevertheless, this does not fully account for the differences observed by age.\\u003c/p\\u003e\\n\\u003cp\\u003eIn conclusion, older patients with HF receive fewer therapies with proven prognostic benefit than younger patients, even when followed in accredited HF units. Mortality and HF decompensations are more frequent in this population, with both cardiovascular and non-cardiovascular comorbidities exerting a significant impact on outcomes. These findings highlight the need for a comprehensive, multidisciplinary approach to managing chronic HF in Spain, ensuring that older patients receive optimal care tailored to their disease stage and the presence of geriatric syndromes.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eCV: cardiovascular\\u003c/p\\u003e\\n\\u003cp\\u003eHF: heart failure\\u003c/p\\u003e\\n\\u003cp\\u003eHFpEF: heart failure with preserved ejection fraction\\u003c/p\\u003e\\n\\u003cp\\u003eHFmrEF: heart failure with mildly reduced ejection fraction\\u003c/p\\u003e\\n\\u003cp\\u003eHFrEF: heart failure with reduced ejection fraction\\u003c/p\\u003e\\n\\u003cp\\u003eSEC: Spanish Society of Cardiology\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eSources of funding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis work does not receive any external funding. R. Gonzalez-Manzanares holds a Juan Rod\\u0026eacute;s research contract (JR24/00064; Instituto de Salud Carlos III, Madrid, Spain).\\u003c/p\\u003e\\n\\u003cp\\u003eThis registry is supported by an unconditional grant from ROVI Laboratories.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflicts of interest\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThere are no conflicts of interest for this work.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eStudy design: AEF, JLBP, JM, MAS. Manuscript preparation: AEF, JM. Manuscript review, editing, and acceptance: all authors. \\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eEsteban-Fern\\u0026aacute;ndez A, Anguita-S\\u0026aacute;nchez M, Anguita-G\\u0026aacute;mez M, Rosillo N, del Prado N, Bernal JL. 30-day readmissions for circulatory system diseases in patients over 75 years with heart failure in Spain (2016-2018). \\u003cem\\u003eRev Esp Cardiol (Engl Ed)\\u003c/em\\u003e. 2023;76(8):655-656.\\u003c/li\\u003e\\n\\u003cli\\u003eAnguita G\\u0026aacute;mez M, Esteban Fern\\u0026aacute;ndez A, Garc\\u0026iacute;a M\\u0026aacute;rquez M, del Prado N, Elola Somoza FJ, Anguita S\\u0026aacute;nchez M. Age and stabilization of admissions for heart failure in Spain (2006-2019). 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A nationwide data from public hospitals in Spain between 2016 and 2018. \\u003cem\\u003eClin Res Cardiol.\\u003c/em\\u003e 2023;112(8):1119-1128.\\u003c/li\\u003e\\n\\u003cli\\u003eChivite D, Formiga F, Corbella X, et al. Basal functional status predicts one-year mortality after a heart failure hospitalization in elderly patients \\u0026mdash; The RICA prospective study. \\u003cem\\u003eInt J Cardiol\\u003c/em\\u003e. 2018;254:182-188.\\u003c/li\\u003e\\n\\u003cli\\u003eKrumholz HM, Merrill AR, Schone EM, et al. Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission. \\u003cem\\u003eCirc Cardiovasc Qual Outcomes\\u003c/em\\u003e. 2009;2(5):407-413.\\u003c/li\\u003e\\n\\u003cli\\u003eMasip J, Formiga F, Com\\u0026iacute;n-Colet J, Corbella X. Short term prognosis of heart failure after first hospital admission. \\u003cem\\u003eMed Clin (Barc)\\u003c/em\\u003e. 2020;154(2):37-44.\\u003c/li\\u003e\\n\\u003cli\\u003eAnker SD, Karakas M, Mentz RJ, et al. Systematic review and meta-analysis of intravenous iron therapy for patients with heart failure and iron deficiency. \\u003cem\\u003eNat Med\\u003c/em\\u003e. 2025;31(8):2640-2646.\\u003c/li\\u003e\\n\\u003cli\\u003eEsteban-Fern\\u0026aacute;ndez A, Bonilla-Palomas JL, Ayesta-L\\u0026oacute;pez A, et al. Justification and design of the BOCADOS-IC study: Nutritional management in adults followed in Spanish hospitals for heart failure. \\u003cem\\u003eRev Esp Geriatr Gerontol\\u003c/em\\u003e. 2025;60(2).\\u003c/li\\u003e\\n\\u003cli\\u003eEsteban-Fern\\u0026aacute;ndez A, Villar-Taibo R, Alejo M, et al. Diagnosis and Management of Malnutrition in Patients with Heart Failure. \\u003cem\\u003eJ Clin Med\\u003c/em\\u003e. 2023;12(9).\\u003c/li\\u003e\\n\\u003cli\\u003eD\\u0026iacute;ez-Villanueva P, Jim\\u0026eacute;nez-M\\u0026eacute;ndez C, P\\u0026eacute;rez-Rivera \\u0026Aacute;, et al. Different impact of chronic kidney disease in older patients with heart failure according to frailty. \\u003cem\\u003eEur J Intern Med\\u003c/em\\u003e. 2025;132:90-96.\\u003c/li\\u003e\\n\\u003cli\\u003eMcDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. \\u003cem\\u003eEur Heart J\\u003c/em\\u003e. 2021;42(36):3599-3726.\\u003c/li\\u003e\\n\\u003cli\\u003eMcDonagh TA, Metra M, Adamo M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. \\u003cem\\u003eEur Heart J\\u003c/em\\u003e. 2023;44(37):3627-3639.\\u003c/li\\u003e\\n\\u003cli\\u003eBarra S, Provid\\u0026ecirc;ncia R, Paiva L, Heck P, Agarwal S. Implantable cardioverter-defibrillators in the elderly: rationale and specific age-related considerations. \\u003cem\\u003eEuropace\\u003c/em\\u003e. 2015;17(2):174-186.\\u003c/li\\u003e\\n\\u003cli\\u003eBehon A, Merkel ED, Schwertner WR, et al. Long-term outcome of cardiac resynchronization therapy patients in the elderly. \\u003cem\\u003eGeroscience\\u003c/em\\u003e. 2023;45(4):2289-2301.\\u003c/li\\u003e\\n\\u003cli\\u003eGrieco D, Bressi E, Sedl\\u0026aacute;ček K, et al. Feasibility and safety of left bundle branch area pacing-cardiac resynchronization therapy in elderly patients. \\u003cem\\u003eJ Interv Card Electrophysiol\\u003c/em\\u003e. 2023;66(2):311-321.\\u003c/li\\u003e\\n\\u003cli\\u003eFujiyoshi K, Minami Y, Yamaoka-Tojo M, et al. Effect of cardiac rehabilitation on cognitive function in elderly patients with cardiovascular diseases. \\u003cem\\u003ePLoS One\\u003c/em\\u003e. 2020;15(5).\\u003c/li\\u003e\\n\\u003cli\\u003eIjaz N, Buta B, Xue QL, et al. Interventions for Frailty Among Older Adults With Cardiovascular Disease: JACC State-of-the-Art Review. \\u003cem\\u003eJ Am Coll Cardiol\\u003c/em\\u003e. 2022;79(5):482-503.\\u003c/li\\u003e\\n\\u003cli\\u003eKitagawa T, Hidaka T, Naka M, et al. Current Medical and Social Issues for Hospitalized Heart Failure Patients in Japan and Factors for Improving Their Outcomes - Insights From the REAL-HF Registry. \\u003cem\\u003eCirc Rep\\u003c/em\\u003e. 2020;2(4):226-234.\\u003c/li\\u003e\\n\\u003cli\\u003eCom\\u0026iacute;n-Colet J, Enjuanes C, Lup\\u0026oacute;n J, Cainzos-Achirica M, Badosa N, Verd\\u0026uacute; JM. Transitions of Care Between Acute and Chronic Heart Failure: Critical Steps in the Design of a Multidisciplinary Care Model for the Prevention of Rehospitalization. \\u003cem\\u003eRev Esp Cardiol (Engl Ed)\\u003c/em\\u003e. 2016;69(10):951-961.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable 1. Characteristics of patients included according to age\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"574\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCharacteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;75 years\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN=1,267\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026ge;75 years\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN=973\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eType of inclusion-n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eHospitalized\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e753 (59.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e737 (75.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eOutpatient\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e514 (40.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e236 (24.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003ePrevious follow-up in HF unit\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e495/1267 (39.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e284/972 (29.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eType of HF unit\\u003c/strong\\u003e\\u003cstrong\\u003e-n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.024\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eCommunity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e213 (16.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e194 (19.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eSpecialized\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e850 (67.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e656 (67.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eAdvanced\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e204 (16.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e123 (12.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eSex (male)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e915 (72.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e527 (54.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePrevious HF-n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eLVEF \\u0026lt;40%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e817/1221 (66.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e397/941 (42.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eLVEF 41-49%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e137/1221 (11.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e132/941 (14.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eLVEF \\u0026gt;50%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e267/1221 (21.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e412/941(43.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHF diagnosis-n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.04\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eNew diagnosis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e535 (42.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e369 (37.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eChronic HF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e732 (57.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e604 (62.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eHF hospitalizations in the previous year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e411 (32.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e305 (31.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.583\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHF etiology-n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eIschemic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e414 (32.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e281 (28.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eValvular heart disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e128 (10.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e219 (22.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eDilated cardiomyopathy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e237 (18.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e95 (9.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eArrythmia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e174 (13.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e152 (15.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eHypertensive\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e68 (5.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e106 (10.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCV risk factors-n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eArterial hypertension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e803/1266 (63.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e825/972 (84.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eDiabetes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e536/1266 (42.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e454/971 (46.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.037\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eCurrent smoker\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e289/1266 (22.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e50/972 (5.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCV comorbidities-n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eAcute coronary syndrome\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e383 (30.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e289 (29.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.787\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eCoronary intervention\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.136\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003ePercutaneous\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e326 (25.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e220 (22.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eCoronary artery bypass grafting\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e61 (4.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e43 (4.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eHybrid\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e22 (1.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e27 (2.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eValvular heart disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e365/1266 (28.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e430/973 (44.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eAtrial fibrillation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eParoxysmal\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e187 (14.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e161 (16.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003ePersistent\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e159 (12.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e91 (9.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003ePermanent\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e228 (18.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e347 (35.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-CV comorbidities-n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eChronic kidney disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e348/1265 (27.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e497/971 (51.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eStroke\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e122/1266 (9.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e104/971 (10.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.404\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eCOPD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e202/1266 (16.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e162/972 (16.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.651\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eOSA with CPAP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e175/1266 (13.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e95/972 (9.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.004\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDementia\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e23/1266 (1.82)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e56/972 (5.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eHemiplegia, paraplegia and functional disability\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e32/1265 (2.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e37/972 (3.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.083\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eActive cancer/lymphoma/leukemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e67/1266 (5.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e79/972 (8.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.007\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eTrauma or falls in the last year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e44/1266 (3.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e48/972 (4.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.084\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eAnemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e309/1266 (24.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e419/971 (43.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0,001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eIron deficiency\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e360/1260 (28.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e398/968 (41.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0,001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eSignificant hyponatremia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e40/1265 (3.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e32/972 (3.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.863\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 286px;\\\"\\u003e\\n \\u003cp\\u003eMalnutrition\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 116px;\\\"\\u003e\\n \\u003cp\\u003e42/1266 (3.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e53/972 (5.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.013\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eCOPD: chronic obstructive pulmonary disease; CPAP: continuous positive airway pressure; CV: cardiovascular; HF: heart failure; LVEF: left ventricular ejection fraction; OSA: obstructive sleep apnea.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2. Clinical and analytical parameters of patients included according to age\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCharacteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;75 years\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN=1,267\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026ge;75 years\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN=973\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFunctional class-n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eNYHA I\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e165 (13.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e34 (3.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eNYHA II\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e473 (37.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e339 (35.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eNYHA III\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e491 (39.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e460 (47.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eNYHA IV\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e130 (10.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e133 (13.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHF categories-n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eHFrEF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e817 (66.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e397 (42.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eHFmrEF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e137 (11.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e132 (14.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eHFpEF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e267 (21.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e412 (43.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eClinical parameters\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eBMI (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e28.0 (24.7;32.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e26.6 (24.7; 32,0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eSBP (mmHg)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e112 (100;125)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e118 (105;130)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eHR (bpm)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e70 (62;80)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e70 (62;80)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0,957\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eLeft bundle branch block-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e259/1264 (20.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e241/973 (24.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.016\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eLVEF (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e35 (26-45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e45 (32-58)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBlood parameters\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eHb (g/dL)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e13.8 (12.0;15.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e12.5 (11.0-14.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eNa (mEq/L)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e139 (137;141)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e139 (137;141)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.332\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eK (mEq/L)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e4.3 (4.0;4.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e4.2 (3.9;4.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.014\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eGFR (mL/min)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e68 (52;87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e49 (35;66)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eGFR\\u0026lt;30 mL/min-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e80/1165 (6.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e144/918 (15.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003e\\n \\u003cp\\u003eNTproBNP (pg/mL)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e1500 (648;3557)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 127px;\\\"\\u003e\\n \\u003cp\\u003e2636 (1227;5716)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eBMI: body mass index; BPM: beats per minute; CV: cardiovascular; GFR: glomerular filtration rate; Hb: hemoglobin; HF: heart failure; HFmrEF: heart failure with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction; HR: heart rate; K: potassium; LVEF: left ventricular ejection fraction; Na: sodium; NYHA: New York Heart Association; SBP: systolic blood pressure.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3. Pharmacological treatment, devices, and outpatient programs based on age\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCharacteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;75 years\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN=1,267\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026ge;75 years\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN=973\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eACEi/ARB/SV-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e1025/1264 (81.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e673/972 (69.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eACEi/ARB/SV in LVEF\\u0026lt;40%-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e715/815 (87.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e315/397 (79.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eBB-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e1099/1262 (87.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e717/972 (73.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eBB in LVEF\\u0026lt;40%-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e751/813 (92.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e329/397 (82.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eMRA-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e891/1264 (70.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e449/972 (46.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eMRA in LVEF\\u0026lt;40%-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e663/815 (81.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e257/397 (64.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eSGLT2i-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e788/1263 (62.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e408/971 (42.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eSGLT2i in LVEF\\u0026lt;40%-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e568/815 (69.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e222/397 (55.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eQuadruple therapy-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e552/1261 (43.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e193/971 (19.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eQuadruple therapy in LVEF\\u0026lt;40%-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e438/813 (53.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e142/397 (35.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eDiuretics-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e968/1264 (76.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e847/971 (87.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eDigoxin-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e104/1263 (8.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e68/971 (7.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.279\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eK-binders-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e33/1263 (2.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e20/971 (2.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.394\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eAntiplatelet agents-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e425/1263 (33.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e308/971 (31.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.335\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eDirect oral anticoagulants-n (%)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e437 (34.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e439 (45.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eAnti-vitamin K anticoagulants-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e231 (18.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e176 (18.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eElectronic device-n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eCRT\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e16 (1.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e29 (3.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eICD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e139 (11.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e38 (3.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eCRT-ICD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e103 (8.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e38 (3.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eConventional pacemaker-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e41 (3.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e127 (13.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eHF program*-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e1007/1263 (79.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e744/969 (76.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.093\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 221px;\\\"\\u003e\\n \\u003cp\\u003eCardiac rehabilitation program-n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e172/1262 (13.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e47/969 (4.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e*Follow-up plan established with multidisciplinary team, including nursing and primary care\\u003c/p\\u003e\\n\\u003cp\\u003eACEi: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; BB: beta-blocker; CRT: cardiac resynchronization therapy; ICD: implantable cardioverter defibrillator; HF: heart failure; K: potassium; LVEF: left ventricular ejection fraction; MRA: mineralocorticoid receptor antagonist; SGLT2i: sodium-glucose cotransporter 2 inhibitor; SV: sacubitril-valsartan.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 4. Incidence of the composite endpoint during follow-up according to age\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"579\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"bottom\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTime\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" style=\\\"width: 245px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt; 75 years\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" style=\\\"width: 245px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026ge; 75 years\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 163px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95% CI\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 163px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95% CI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e1 month\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e97.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e96.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e98.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e95.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e94.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e96.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e3 months\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e91.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e89.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e92.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e86.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e84.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e88.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e6 months\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e85.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e83.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e87.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e78.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e75.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e81.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e9 months\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e81.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e78.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e83.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e74.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e71.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e76.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e1 year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e77.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e74.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e79.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e66.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e63.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e69.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eCI: confidence interval; P: percentage\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 5. Predictors of composite outcome based on age\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"546\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"bottom\\\" style=\\\"width: 213px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" style=\\\"width: 171px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt; 75 years\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN=1,154\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" style=\\\"width: 162px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026ge; 75 years\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN=906\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHR (95% CI )\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHR (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 213px;\\\"\\u003e\\n \\u003cp\\u003eGFR \\u0026lt; 30 mL/min\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.55 (1.07-2.26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.022\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.38 (1.04-1.83)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.024\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 213px;\\\"\\u003e\\n \\u003cp\\u003eHospital-based inclusion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.73 (1.27-2.38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.85 (1.29-2.65)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 213px;\\\"\\u003e\\n \\u003cp\\u003ePrevious HF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.73 (1.31-2.29)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.57 (1.21-2.04)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 213px;\\\"\\u003e\\n \\u003cp\\u003eIschemic etiology of HF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.38 (1.07-1.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.014\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.34 (1.05-1.71)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.019\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 213px;\\\"\\u003e\\n \\u003cp\\u003eFunctional class NYHA III-IV\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.60 (1.20-2.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.39 (1.05-1.84)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 213px;\\\"\\u003e\\n \\u003cp\\u003ePrevious TRC/ICD implant\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.50 (1.03-2.17)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.032\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.69 (1.07-2.69)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.025\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 213px;\\\"\\u003e\\n \\u003cp\\u003ePrevious valvular heart disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.49 (1.16-1.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.002\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.10 (0.87-1.39)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.428\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 213px;\\\"\\u003e\\n \\u003cp\\u003ePrevious atrial fibrillation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.46 (1.13-1.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.004\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.35 (1.05-1.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.019\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 213px;\\\"\\u003e\\n \\u003cp\\u003eHemiplegia, paraplegia, functional disability\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.92 (1.04-3.58)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.039\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.52 (0.95-2.45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.080\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 213px;\\\"\\u003e\\n \\u003cp\\u003eAnemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.37 (1.05-1.78)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.019\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.40 (1.11-1.78)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.005\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 213px;\\\"\\u003e\\n \\u003cp\\u003eMalnutrition\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.71 (1.03-2.86)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.040\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e1.53 (1.03-2.26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.035\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eCI: confidence interval; CRT: cardiac resynchronization therapy; GFR: glomerular filtration rate; HF: heart failure; HR: hazard ratio; ICD: for implantable cardioverter defibrillator; NYHA: New York Heart Association.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"european-geriatric-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"EGEM\",\"sideBox\":\"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)\",\"snPcode\":\"41999\",\"submissionUrl\":\"https://www.editorialmanager.com/egem/default2.aspx\",\"title\":\"European Geriatric Medicine\",\"twitterHandle\":\"\",\"acdcEnabled\":false,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"Heart failure, older patients, SEC-Excelente, prognosis, multidisciplinary care\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7952728/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7952728/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe 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 (\\u0026lt; 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.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMedian 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 \\u0026lt; 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 \\u0026lt; 0.001). At 1 year, event-free survival was 66.3% in older vs 77.0% in younger patients (log-rank p \\u0026lt; 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.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOlder 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.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Age-based analysis of the SEC-Excelente-HF registry: clinical characteristics and prognosis of a prospective cohort of heart failure patients.\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-11-21 18:13:41\",\"doi\":\"10.21203/rs.3.rs-7952728/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Major revisions\",\"date\":\"2025-12-10T13:17:03+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"\",\"date\":\"2025-12-04T07:42:33+00:00\",\"index\":0,\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-11-11T14:57:33+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"European Geriatric Medicine\",\"date\":\"2025-11-04T10:43:55+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-10-29T08:17:43+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"European Geriatric Medicine\",\"date\":\"2025-10-27T03:00:30+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"european-geriatric-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"EGEM\",\"sideBox\":\"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)\",\"snPcode\":\"41999\",\"submissionUrl\":\"https://www.editorialmanager.com/egem/default2.aspx\",\"title\":\"European Geriatric Medicine\",\"twitterHandle\":\"\",\"acdcEnabled\":false,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"4132a818-946f-4439-b828-7b359000a7f5\",\"owner\":[],\"postedDate\":\"November 21st, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-12-16T21:27:28+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-11-21 18:13:41\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7952728\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7952728\",\"identity\":\"rs-7952728\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}