Age-related changes in clinical characteristics and outcomes of chronic heart failure outpatients in a cardiology setting. A report from the Italian Network on Heart Failure. (1st January 2022)

• Record Type: Journal Article
• Authors: Gori, Mauro; Marini, Marco; De Maria, Renata; Gonzini, Lucio; Gorini, Marco; Cassaniti, Leonarda; Benvenuto, Manuela; Municinò, Annamaria; Navazio, Alessandro; Ammirati, Enrico; Leonardi, Giuseppe; Pagnoni, Nicoletta; Montagna, Laura; Catalano, Mariarosaria; Midi, Paolo; Floresta, Agata Marina; Pulignano, Giovanni; Maggioni, Aldo P.; Tavazzi, Luigi; Iacoviello, Massimo
• Is Part Of: International journal of cardiology. Volume 346(2022)
• Page Start: 36
• Page End: 44
• Publication Date: 2022-01-01
• Subjects: Heart failure -- Age -- Temporal trend -- Cardiology setting; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.11.014
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: Ageing and comorbidities are increasing frailty/complexity of heart failure (HF) patients globally. We assessed evolving trends over two decades according to patients' age and time of recruitment in a nationwide cardiology setting in Italy. Methods and results: Chronic HF outpatients recruited between 1999 and 2018 ( N = 14, 823) were divided into 3 cohorts: 1999–2005 ( N = 5404); 2006–2011 ( N = 3971); 2012–2018 ( N = 5448). We analyzed temporal changes in clinical characteristics, therapies, and outcome (1-year all-cause mortality/cardiovascular hospitalization), overall and by age group: <65 ( n = 5465); 65–79 ( n = 6838); ≥80 ( n = 2520) years old. Across enrolment epochs, comorbidities (atrial fibrillation, hypertension, obesity) increased by both epoch/age groups ( p < 0.001), whereas the prevalence of ischemic etiology declined among patients ≥65 years ( p = 0.05). Accordingly, the preserved LVEF phenotype (HFpEF) increased in all age categories (p < 0.001) over time. Moreover, the use of betablockers, mineralocorticoid-receptor antagonists and loop-diuretics rose by enrolment epoch in all age groups ( p < 0.05). In parallel with these epidemiologic/treatment changes, age-adjusted survival free from cardiovascular hospitalization improved over time ( p < 0.0001). However, divergent trends in the end-point components were apparent according to age groups: mortality decreased in patients<80 years, although hospitalizations remained stable in the youngest group, while subjects ≥65 years were less likely to be admitted for cardiovascular causes (all p < 0.005). Conclusions: Over two decades in a cardiology outpatient setting, the prevalence of comorbid HFpEF increased in all age categories. Mortality improved among patients<80 years and cardiovascular hospitalizations decreased in patients≥65 years. These findings point to the value of cardiologist' input in the management of adult chronic HF patients at all ages. Graphical abstract: Unlabelled Image Highlights: Frailty and complexity of heart failure (HF) patients are increasing globally. We studied trends over 2 decades among chronic HF outpatients in cardiology settings. Comorbidities and the preserved ejection fraction phenotype increased in all age groups. Guideline-directed medical therapy rose across age categories. Age-adjusted survival free from cardiovascular hospitalization improved over time.