Author + information
- Received March 22, 2019
- Revision received May 13, 2019
- Accepted May 21, 2019
- Published online July 29, 2019.
- Jasper Tromp, MD, PhDa,b,
- Li Shen, MBChB, PhDc,
- Pardeep S. Jhund, MBChB, PhDc,
- Inder S. Anand, MD, DPhild,
- Peter E. Carson, MDe,
- Akshay S. Desai, MD, MPHf,
- Christopher B. Granger, MDg,
- Michel Komajda, MDh,
- Robert S. McKelvie, MD, PhDi,
- Marc A. Pfeffer, MD, PhDf,
- Scott D. Solomon, MDf,
- Lars Køber, MD, DMScj,
- Karl Swedberg, MD, PhDk,
- Michael R. Zile, MDl,
- Bertram Pitt, MD, PhDm,
- Carolyn S.P. Lam, MBBS, PhDa,b and
- John J.V. McMurray, MDc,∗ (, )@UofGlasgow
- aNational Heart Centre Singapore and Duke-NUS Medical School, Singapore
- bDepartment of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- cBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- dDepartment of Medicine, University of Minnesota Medical School and VA Medical Center, Minneapolis, Minnesota
- eDepartment of Cardiology, Washington VA Medical Center, Washington, DC
- fDepartment of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- gDuke Clinical Research Institute, Duke University, Durham, North Carolina
- hDepartment of Cardiology, Hospital Saint Joseph, Paris, France
- iWestern University, London, Ontario, Canada
- jDepartment of Cardiology, Rigshospitalet, Copenhagen, Denmark
- kDepartment of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and National Heart and Lung Institute, Imperial College, London, United Kingdom
- lMedical University of South Carolina and Ralph H. Johnston Veterans Administration Medical Center, Charleston, South Carolina
- mDepartment of Internal Medicine-Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan
- ↵∗Address for correspondence:
Dr. John J.V. McMurray, British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, United Kingdom.
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 m2). 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)
Dr. Jhund has received advisory board fees, speaker fees, or consultancy fees from Novartis, Vifor Pharma, Boehringer Ingelheim, and Cytokinetics; and has received research grants from Boehringer Ingelheim. Dr. Desai has served as a consultant for and received research grants from Novartis; and has served as a consultant for Abbott, AstraZeneca, Boehringer Ingelheim, Boston Scientific, DalCor Pharma, Corvidia, Regeneron, Relypsa, and Zogenix. Dr. Granger has received research grants and/or consulting/speaking fees from Abbvie, AKROS, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi-Sankyo, Espero BioPharma, the U.S. Food and Drug Administration, GlaxoSmithKline, Janssen, Medscape, Medtronic, Medtronic Foundation, Merck, National Institutes of Health, Novo Nordisk, Novartis, Pfizer, and Roche Diagnostics. Dr. Komajda has served as a consultant for Novartis, Servier, Sanofi, Merck Sharp & Dohme, and AstraZeneca; and has served as a speaker for Novartis, Servier, and Merck Sharp & Dohme. Dr. Pfeffer has received research grant support from Novartis; has served as a consultant for AstraZeneca, Corvidia, DalCor, GlaxoSmithKline, Jazz, MyoKardia, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Servier, and Takeda; and has stock options in DalCor (zero dollars). Dr. Solomon has received research grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol-Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lone Star Heart, Mesoblast, MyoKardia, National Institutes of Health/National Heart, Lung, and Blood Institute, Novartis, Sanofi Pasteur, and Theracos; and has served as a consultant for Akros, Alnylam, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Cardior, Corvia, Cytokinetics, Gilead, GlaxoSmithKline, Ironwood, Merck, Myokardia, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions, and Tenaya. Dr. Swedberg has served on the Advisory Board of AstraZeneca, Novartis, and Pfizer. Dr. Pitt has served as a consultant for Bayer, AstraZeneca, Sanofi, KBP Pharmaceuticals, Vifor, scPharmaceuticals, Cereno, and Sarfez; and has stock options in Sarfez, KBP Pharmaceuticals, and scPharmaceuticals. Dr. Lam has received research support from Boston Scientific, Bayer, Roche Diagnostics, AstraZeneca, Medtronic, and Vifor Pharma; and has served on the Advisory Board/Steering Committee/Executive Committee for Boston Scientific, Bayer, Roche Diagnostics, AstraZeneca, Medtronic, Vifor Pharma, Novartis, Amgen, Merck, Janssen Research & Development LLC, Menarini, Boehringer Ingelheim, NovoNordisk, Abbott Diagnostics, Corvia, Stealth BioTherapeautics, JanaCare, Biofourmis, and Darma. Dr. McMurray’s employer, Glasgow University, has been paid by AstraZeneca (who market dapagliflozin) for his time spent as Principal Investigator of DAPA-HF and Co-Principal Investigator of DELIVER (trials using dapagliflozin) in heart failure and meetings related to trial, as well as for travel and accommodations for these meetings; Glasgow University has also been paid by Novartis for time spent as an Executive Committee member and then Co-Principal Investigator of ATMOSPHERE, Co-Principal Investigator of the PARADIGM-HF and PARAGON-HF trials, and Executive/Steering Committee member for PARADISE-MI and PERSPECTIVE trials (with sacubitril/valsartan) and meetings/presentations related to these trials and aliskiren and sacubitril/valsartan as well as for travel and accommodations for these meetings; and he has had other clinical trial relationships with Kidney Research UK, Vifor-Fresenius Pharma, Bayer, Cardiorentis, Amgen, Oxford University/Bayer, Theracos, Abbvie, DalCor, Pfizer, Merck, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, and Novartis; all payments were made through a consultancy with Glasgow University and were not personal payments in relation to this trial/this drug. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received March 22, 2019.
- Revision received May 13, 2019.
- Accepted May 21, 2019.
- 2019 American College of Cardiology Foundation
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