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

Tobias 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.
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