Schmid V; School of Medicine and Health, TUM University Hospital, Munich, Germany.
Paterson S; Weinkauf C; Wang J; et al

GeroScience. 48(3):4827-4845, 2026 Jun.

Reduced peak oxygen uptake (VO2peak) is a hallmark of heart failure (HF)
and aging, but studies on VO2peak in older HF patients are limited. We
compared VO2peak in older HF patients versus controls and investigated
differences across the age continuum: young-old (YO, 60-69 years),
middle-old (MO, 70-79 years), and oldest-old (OO, >= 80 years). PubMed was
searched (1967 May 2024) for studies meeting the following inclusion
criteria: (1) HF patients with mean age >= 65 years; (2) VO2peak measured
via maximal cardiopulmonary exercise testing, and (3) control group for
aim 1. For aim 2, studies had to compare VO2peak within the age-subgroups.
Random-effects meta-analysis was conducted, comparing VO2peak (primary
aim, and Fick determinants when reported) between HF and controls (aim 1),
and VO2peak between older age-subgroups (aim 2). Results are presented as
weighted mean differences (WMD) with 95% confidence intervals. From 2788
screened articles, 38 studies were included. For aim 1, 30 studies (HF: n
= 1093, mean age 70 years, 46% female; controls: n = 942, mean age 69
years, 52% female) demonstrated a significantly lower VO2peak in HF (WMD –
8.8 mL/kg/min, [95% CI] – 10.3 to – 7.3 mL/kg/min). In the subset of
patients where Fick determinants were measured, peak cardiac output and
heart rate were lower in HF versus controls. For aim 2, eight studies
showed progressively lower VO2peak with age: MO vs. YO (- 1.5 mL/kg/min)
and OO vs. MO (- 1.2 mL/kg/min). Older HF patients exhibit significant
VO2peak reductions compared to controls, with progressively lower VO2peak
values observed across the older age continuum.