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

Journal article
Authors J. Tromp
L. Shen
P. S. Jhund
I. S. Anand
P. E. Carson
A. S. Desai
C. B. Granger
M. Komajda
R. S. McKelvie
M. A. Pfeffer
S. D. Solomon
L. Kober
Karl Swedberg
M. R. Zile
B. Pitt
C. S. P. Lam
J. J. V. McMurray
Published in Journal of the American College of Cardiology
Volume 74
Issue 5
Pages 601-612
ISSN 0735-1097
Publication year 2019
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 601-612
Language en
Links dx.doi.org/10.1016/j.jacc.2019.05.0...
Keywords heart failure, HFpEF, race, young, clinical characteristics, young-adults, racial-differences, cardiac, structure, death, hfpef, spironolactone, comorbidities, predominance, dysfunction, Cardiovascular System & Cardiology
Subject categories Cardiac and Cardiovascular Systems

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 m(2)). 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) (C) 2019 by the American College of Cardiology Foundation.

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