Age-Related Outcomes in Heart Failure with Mildly Reduced Ejection Fraction

Clin Res Cardiol (2024). DOI 10.1007/s00392-024-02406-5
T. Schupp (Mannheim)¹, M. Reinhardt (Mannheim)¹, A. Schmitt (Mannheim)¹, F. Lau (Mannheim)¹, A. Noah (Mannheim)¹, M. Akin (Hannover)², J. Rusnak (Heidelberg)³, K. J. Weidner (Mannheim)¹, I. Akin (Mannheim)¹, M. Behnes (Mannheim)^1
1Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland; ²Medizinische Hochschule Hannover Kardiologie und Angiologie Hannover, Deutschland; ³Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland

Objective: The study investigates age-related differences and outcomes in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF).
Background: The characterization of patients with HFmrEF and the prognostic value of age has rarely been investigated.

Methods: Consecutive patients with HFmrEF (i.e., left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. The distribution of HF etiology, as well as prognostic outcomes were assessed comparing patients with ≤40, >40 to ≤60, >60 to ≤80 and >80 years of age. The primary endpoint was all-cause mortality at 30 months (median follow-up), the key secondary endpoint was rehospitalization for worsening HF. Statistical analyses comprised Kaplan-Meier and multivariable Cox proportional regression analyses. Results: 2,184 patients with HFmrEF with a median age of 76 years (mean 72, IQR 72 – 73 years) were included. Non-ischemic cardiomyopathy was the most common HF etiology in patients < 40 years of age, whereas patients with 60 – 80 years of age (60.2%) and > 80 years of age (58.2%) had the higher rates of ischemic cardiomyopathies. The risk of all-cause mortality (HR = 2.167; 95% CI 1.928 – 2.436; p = 0.001) was highest in patients with > 80 years of age compared to younger patients, which was confirmed after multivariable adjustement (HR = 4.077; 95% CI 1.863 – 8.920; p = 0.001). Furthermore, patients with > 80 years of age had the highest risk of HF-related rehospitalization (HR = 1.529; 95% CI 1.293 – 1.807; p = 0.001).

Conclusion: Ischemic cardiomyopathy represents the most common cause of HF in elderly patients with HFmrEF, whereas younger patients were more likely to suffer from non-ischemic HF etiologies. Increasing age was an independent predictor of adverse outcomes in patients hospitalized with HFmrEF.