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

• Published in: International journal of cardiology Vol. 346; pp. 36 - 44
• Main 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
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2022
• Subjects: Age; Aged, 80 and over; Cardiology; Cardiology setting; Heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - therapy; Hospitalization; Humans; Outpatients; Prognosis; Stroke Volume; Temporal trend; Heart failure; Cardiology setting; Age; Temporal trend
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2021.11.014

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. 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). 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. [Display omitted] •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.