Log in to MyACC
Age-Related Aspects of Heart Failure With Preserved Ejection Fraction
Study Questions:
What are the associations among age, clinical characteristics, and outcomes in patients with heart failure with preserved ejection fraction (HFpEF)?
Methods:
The study authors used data on HFpEF patients (left ventricular EF ≥45%) from three large 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]). Using these data, patients were categorized according to age: ≤55 years (n = 522), 56-64 years (n = 1,679), 65-74 years (n = 3,405), 75-84 years (n = 2,464), and ≥85 years (n = 398). The authors compared clinical and echocardiographic characteristics, as well as mortality and hospitalization rates, mode of death, and quality of life across age categories. The primary outcome in the present analysis was all-cause mortality censored at 5 years. Secondary outcomes included cause-specific mortality (cardiovascular [CV] vs. non-CV) at 5 years and hospitalization for HF within 5 years as well as a composite outcome of CV death or HF hospitalization within 5 years.
Results:
Of the 8,468 patients analyzed, 6.2% were ≤55 years (n = 522), 19.8% (n = 1,679) were between 56 and 64 years, 40.2% (n = 3,405) were between 65 and 74 years, 29.1% (n = 2,464) were between 75 and 84 years, and 4.7% (n = 398) were ≥85 years of age. Compared with younger patients, older patients were more often white women, with a higher New York Heart Association functional class, lower estimated glomerular filtration rate (eGFR), and worse overall signs. Younger patients (ages ≤55 years) with HFpEF were more often obese (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.7-2.1), men (OR, 1.9; 95% CI, 1.7-2.2), and of Asian (OR, 2.4; 95% CI, 1.4-4.1) or black (OR, 2.8; 95% CI, 2.3-3.5) race, 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 (ages ≥85 years); this association remained significant after correction for gender, history of atrial fibrillation, diabetes, and body mass index (p < 0.05 for all). Compared with patients ages ≤55 years, patients ages ≥85 years had higher mortality (hazard ratio, 6.9; 95% CI, 4.2-11.4). However, among patients who died, sudden death was the most common mode of mortality (p < 0.001) in patients ages ≤55 years. In contrast, older patients (ages ≥85 years) died more often from non-CV causes (34% vs. 20% in patients ages ≤55 years; p < 0.001).
Conclusions:
The authors concluded that compared with the elderly, younger patients with HFpEF were less likely to be white, were more frequently obese men, and died more often of CV causes, particularly sudden death. In contrast, elderly patients with HFpEF had more comorbidities and died more often from non-CV causes.
Perspective:
This is an important analysis because it suggests that demographics and natural history of HFpEF are very different across different age groups. It raises the question of whether future clinical trials of HFpEF should stratify patients by age. And given the findings of this study that sudden death is more common in younger patients, it raises the question of whether future trials should consider beta-blockade rather than renin-angiotensin-aldosterone system inhibitors in this age group.
Clinical Topics: Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension
Keywords: Atrial Fibrillation, Body Mass Index, Comorbidity, Death, Sudden, Echocardiography, Geriatrics, Glomerular Filtration Rate, Heart Failure, Hypertension, Mineralocorticoid Receptor Antagonists, Obesity, Quality of Life, Renal Insufficiency, Chronic, Renin-Angiotensin System, Secondary Prevention, Stroke Volume
< Back to Listings
