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Original ResearchVolume 74, Issue 5, August 2019

JOURNAL:J Am Coll Cardiol. Article Link

Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction

J Tromp, L Shen, PS Jhund et al. Keywords: age-related characteristics; HFpEF; cause of death

ABSTRACT


BACKGROUND- Although heart failure with preserved ejection fraction (HFpEF) is considered a disease of the elderly, younger patients are not spared from this syndrome.

 

OBJECTIVES- This study therefore investigated the associations among age, clinical characteristics, and outcomes in patients with HFpEF.

 

METHODS- Using data on patients with left ventricular ejection fraction 45% from 3 large HFpEF trials (TOPCAT [Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function], I-PRESERVE [Irbesartan in Heart Failure With Preserved Systolic Function], and CHARM Preserved [Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity]), patients were categorized according to age: 55 years (n = 522), 56 to 64 years (n = 1,679), 65 to 74 years (n = 3,405), 75 to 84 years (n = 2,464), and 85 years (n = 398). This study compared clinical and echocardiographic characteristics, as well as mortality and hospitalization rates, mode of death, and quality of life across age categories.

 

RESULTS - Younger patients (age 55 years) with HFpEF were more often obese, nonwhite men, whereas older patients with HFpEF were more often white women with a higher prevalence of atrial fibrillation, hypertension, and chronic kidney disease (eGFR <60 ml/min/1.73 m2). Despite fewer comorbidities, younger patients had worse quality of life compared with older patients (age 85 years). Compared with patients age 55 years, patients age 85 years had higher mortality (hazard ratio: 6.9; 95% confidence interval: 4.2 to 11.4). However, among patients who died, sudden death was, proportionally, the most common mode of death (p < 0.001) in patients age 55 years. In contrast, older patients (age 85 years) died more often from noncardiovascular causes (34% vs. 20% in patients age 55 years; p < 0.001).

 

CONCLUSIONS - Compared with the elderly, younger patients with HFpEF were less likely to be white, were more frequently obese men, and died more often of cardiovascular causes, particularly sudden death. In contrast, elderly patients with HFpEF had more comorbidities and died more often from noncardiovascular causes. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302; Irbesartan in Heart Failure With Preserved Systolic Function [I-PRESERVE]; NCT00095238; Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity [CHARM Preserved]; NCT00634712)