Heart Failure in Younger Patients
Heart Failure in Younger Patients
Aim Our understanding of heart failure in younger patients is limited. The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) database, which consisted of 24 prospective observational studies and 7 randomized trials, was used to investigate the clinical characteristics, treatment, and outcomes of younger patients.
Methods and Results Patients were stratified into six age categories: <40 (n = 876), 40–49 (n = 2638), 50–59 (n = 6894), 60–69 (n = 12 071), 70–79 (n = 13 368), and ≥80 years (n = 6079). Of 41 926 patients, 2.1, 8.4, and 24.8% were younger than 40, 50, and 60 years of age, respectively. Comparing young (<40 years) against elderly (≥80 years), younger patients were more likely to be male (71 vs. 48%) and have idiopathic cardiomyopathy (63 vs. 7%). Younger patients reported better New York Heart Association functional class despite more severe left ventricular dysfunction (median ejection fraction: 31 vs. 42%, all P < 0.0001). Comorbidities such as hypertension, myocardial infarction, and atrial fibrillation were much less common in the young. Younger patients received more disease-modifying pharmacological therapy than their older counterparts. Across the younger age groups (<40, 40–49, and 50–59 years), mortality rates were low: 1 year 6.7, 6.6, and 7.5%, respectively; 2 year 11.7, 11.5, 13.0%; and 3 years 16.5, 16.2, 18.2%. Furthermore, 1-, 2-, and 3-year mortality rates increased sharply beyond 60 years and were greatest in the elderly (≥80 years): 28.2, 44.5, and 57.2%, respectively.
Conclusion Younger patients with heart failure have different clinical characteristics including different aetiologies, more severe left ventricular dysfunction, and less severe symptoms. Three-year mortality rates are lower for all age groups under 60 years compared with older patients.
Although the overall prevalence of heart failure (HF) in the general adult population is 1–2%, the majority of those affected is elderly. Prior studies on the epidemiology and prognosis of HF have focused on older individuals. There is limited information on the causes and consequences of HF in younger patients (<60 years), especially those aged <40 years. This is primarily because no single epidemiological study, registry, or clinical trial have included sufficient numbers of such individuals to draw robust conclusions. Yet, it is often in these younger patients that the most searching questions about aetiology and prognosis are asked.
The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) has collated individual patient data from 31 studies (24 observational studies including the Euro Heart Failure Survey and 7 randomized controlled trials of either pharmacotherapy or management interventions). These data provide an opportunity to address these deficiencies in our understanding of HF in younger patients.
Abstract and Introduction
Abstract
Aim Our understanding of heart failure in younger patients is limited. The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) database, which consisted of 24 prospective observational studies and 7 randomized trials, was used to investigate the clinical characteristics, treatment, and outcomes of younger patients.
Methods and Results Patients were stratified into six age categories: <40 (n = 876), 40–49 (n = 2638), 50–59 (n = 6894), 60–69 (n = 12 071), 70–79 (n = 13 368), and ≥80 years (n = 6079). Of 41 926 patients, 2.1, 8.4, and 24.8% were younger than 40, 50, and 60 years of age, respectively. Comparing young (<40 years) against elderly (≥80 years), younger patients were more likely to be male (71 vs. 48%) and have idiopathic cardiomyopathy (63 vs. 7%). Younger patients reported better New York Heart Association functional class despite more severe left ventricular dysfunction (median ejection fraction: 31 vs. 42%, all P < 0.0001). Comorbidities such as hypertension, myocardial infarction, and atrial fibrillation were much less common in the young. Younger patients received more disease-modifying pharmacological therapy than their older counterparts. Across the younger age groups (<40, 40–49, and 50–59 years), mortality rates were low: 1 year 6.7, 6.6, and 7.5%, respectively; 2 year 11.7, 11.5, 13.0%; and 3 years 16.5, 16.2, 18.2%. Furthermore, 1-, 2-, and 3-year mortality rates increased sharply beyond 60 years and were greatest in the elderly (≥80 years): 28.2, 44.5, and 57.2%, respectively.
Conclusion Younger patients with heart failure have different clinical characteristics including different aetiologies, more severe left ventricular dysfunction, and less severe symptoms. Three-year mortality rates are lower for all age groups under 60 years compared with older patients.
Introduction
Although the overall prevalence of heart failure (HF) in the general adult population is 1–2%, the majority of those affected is elderly. Prior studies on the epidemiology and prognosis of HF have focused on older individuals. There is limited information on the causes and consequences of HF in younger patients (<60 years), especially those aged <40 years. This is primarily because no single epidemiological study, registry, or clinical trial have included sufficient numbers of such individuals to draw robust conclusions. Yet, it is often in these younger patients that the most searching questions about aetiology and prognosis are asked.
The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) has collated individual patient data from 31 studies (24 observational studies including the Euro Heart Failure Survey and 7 randomized controlled trials of either pharmacotherapy or management interventions). These data provide an opportunity to address these deficiencies in our understanding of HF in younger patients.
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