IJCS | Volume 32, Nº6, November / December 2019

601 Figure 6 - Proportional mortality rates due to heart failure in the period from 2007 to 2015 in Brazil, RS and Porto Alegre. Source: Elaborated by the author based on data obtained from DATASUS (2017). Nicolao et al. Heart failure: morbidity and mortality Int J Cardiovasc Sci. 2019;32(6):596-604 Original Article though there was a decrease in HF hospitalizations in absolute numbers and a decrease in the relation of HF admissions and total admissions, the average length of stay and the mortality rate increased over time. 10 Despite the predominant age range, the I Brazilian Registry of Heart Failure (BREATHE) reported a mean age of 64 years, with 73% of patients above the age of 75 years, in patients admitted with acute HF. 8 The same study showed a variation in the mean age in relation to Brazilian regions, with patients showing higher ages in the South and Southeast regions compared to patients in the North region (on average, 59 years of age). 8-12 Similarly, a pioneer study that portrayed the epidemiological profiles of patients admitted for decompensatedHF between public and private hospitals in the city of Niterói, Rio de Janeiro, reported a mean age of 61.1 years in public hospitals. 13 Other studies published recently indicate a predominance of individuals in the eighth decade of life (70-79 years of age). 10,14,15 Advanced age patients account for a significant fraction of the sample studied. 8 In Porto Alegre, the greatest number of HF admissions occurred in patients within the age range of 60 to 69 years. Data from Porto Alegre are similar to those from an international multicenter trial designed to assess HF patients in 388 centers in North America, Europe, Latin America and Asia, in which the mean age was 67 years. 16 In two previous studies that assessed HF patients in low-income countries, the mean age was 52 to 59 years. 11,17 Regional variation in age may be explained by differences in the prevalence of underlying risk factors, as well as living standards. 18 It is estimated that HF will increase by 46% from 2012 to 2030, resulting in more than 8 million people over 18 years of age with HF. This ascending prevalence is a result of the growth in life expectancy, since HF affects mainly the elderly. 8 Men have higher hospitalization rates for HF according to data from previous studies. 10,13,14,16,19 In this study, we observed a higher prevalence of males in all regions of Brazil and Porto Alegre. On the other hand, in Rio Grande do Sul, the sex ratio indicates an inversion, with a predominance of women, similar to a study carried out in a city of the state of Minas Gerais (Brazil), in which women accounted for 51% of admissions, in the period from 2010 to 2014. 20 Similarly, a previous study performed in public and private hospitals in the city of Niterói (Rio de Janeiro) reported 51% of female hospitalizations in private hospitals. 13 Analysis of global registries of HF patients indicated that 40% to 50% of HF patients are females, a group of patients traditionally under-represented in previous clinical trials. This is a remarkable observation, since female patients are unique in that they tend to be older at the time of initial diagnosis