Non-HFpEF was associated with higher all-cause mortality than HFpEF in older patients (26.6% vs 20.9%, P=0.002), with non-cardiovascular deaths accounting for a greater proportion of deaths in HFpEF.
Cohort (n=3,558)
In patients hospitalized for heart failure, the probability of non-cardiovascular death increases with advancing age and is more prominent in HFpEF, suggesting that mitigating cardiovascular outcomes alone may be insufficient in older populations.
Absolute Event Rate: 26.6% vs 20.9%
p-value: p=0.002
AIMS: The long-term outcome in patients with heart failure (HF) after hospitalization may vary substantially depending on their age and left ventricular ejection fraction (LVEF). We aimed to assess the relative rates of cardiovascular death (CVD) and non-CVD based on the age and how the rates differ under the updated LVEF classification system. METHODS AND RESULTS: Consecutively registered hospitalized patients with HF (N = 3558; 39.7% women with a mean age of 73.9 ± 13.3 years) were followed for a median of 2 (interquartile range, 0.8-3.1) years. The CVDs and non-CVDs were evaluated based on age young (<65 years), older (65-84 years), and very old (≥85 years) and LVEF classification HF with preserved EF (HFpEF; LVEF ≥50%) and non-HFpEF (LVEF <50%). The adverse clinical events were adjudicated independently by a central committee. Overall, 1505 (42.3%) had HFpEF young: n = 182 (12.1%), older: n = 894 (59.4%), very old: n = 429 (28.5%), and 2053 (57.7%) had non-HFpEF young: n = 575 (28.0%), older: n = 1159 (56.5%), very old: n = 319 (15.5%). During the follow-up, the crude incidence of all-cause death was higher in non-HFpEF than in HFpEF across all age groups (non-HFpEF vs. HFpEF, young: 10.4% vs. 5.5%, log-rank P = 0.10; older: 26.6% vs. 20.9%, log-rank P = 0.002; very old: 36.7% vs. 31.7%, log-rank P = 0.043). CVDs accounted for more than half of all deaths in non-HFpEF (young 65.0%, older 64.2%, and very old 55.6%), whereas the proportion of CVDs remained less than half in HFpEF (young 50.0%, older 41.2%, very old 38.2%). HF readmission was associated with subsequent all-cause death in non-HFpEF hazard ratio (HR): 1.72, 95% confidence interval (CI): 1.41-2.09, P < 0.001, but not in HFpEF (HR: 1.12, 95% CI: 0.87-1.43, P = 0.39). CONCLUSIONS: The probability of a non-CVD increases in both LVEF categories with advancing age, but that it is greater in the HFpEF category. The findings indicate that mitigating CV-related outcomes alone may be insufficient for treating HF in older population, particularly in the HFpEF category.
Nakamaru et al. (Sun,) conducted a cohort in Heart failure after hospitalization (n=3,558). Non-HFpEF (LVEF <50%) vs. HFpEF (LVEF ≥50%) was evaluated on All-cause death in older patients (65-84 years) (p=0.002). Non-HFpEF was associated with higher all-cause mortality than HFpEF in older patients (26.6% vs 20.9%, P=0.002), with non-cardiovascular deaths accounting for a greater proportion of deaths in HFpEF.