Excess Risk of Mortality and Hospitalization in Patients with Heart Failure According to Age and Comorbidity - A Nationwide Register Study

• Published in: Clinical epidemiology Vol. 16; pp. 631 - 640
• Main Authors: Madelaire, Christian, Gerds, Thomas, Køber, Lars, Gustafsson, Finn, Andersson, Charlotte, Kristensen, Søren Lund, Butt, Jawad Haider, Zahir Anjum, Deewa, Banke, Ann, Fosbøl, Emil Loldrup, Gislason, Gunnar, Torp-Pedersen, Christian, Schou, Morten
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 30.09.2024; Dove; Dove Medical Press
• Subjects: ACE inhibitors; Angiotensin; Angiotensin converting enzyme; Cardiac patients; Comorbidity; Comparative analysis; Denmark; excess risk; Heart failure; hospitalization; Medical research; Medicine, Experimental; Mortality; Original Research; Patient outcomes; Pharmaceutical industry; United Kingdom; Denmark; United Kingdom; mortality; heart failure; hospitalization; excess risk
• ISSN: 1179-1349; 1179-1349
• DOI: 10.2147/CLEP.S469816

Heart failure (HF) is associated with increased risk of death and a hospitalization, but for patients initiating guideline directed medical therapy, it is unknown how high these risks are compared to the general population - and how this may vary depending on age and comorbidity. In this retrospective cohort study, we identified patients diagnosed with HF in the period 2011-2017, surviving the initial 120 days after diagnosis. Patients who were on angiotensin converting enzyme inhibitor (ACEi)/ angiotensin receptor blocker (ARB) and beta-blocker were included and matched to 5 non-HF individuals from the background population each based on age and sex. We assessed the 5-year risk of all-cause death, HF and non-HF hospitalization according to sex and age and baseline comorbidity. We included 35,367 patients with HF and 176,835 matched non-HF individuals. Patients with HF had a five-year excess risk (absolute risk difference) of death of 13% (31% [for HF] - 18% [for non-HF]), of HF hospitalization of 17% and of non-HF hospitalization of 24%. Excess risk of death increased with increasing age, whereas the relative risk decreased - for women in their twenties, the excess risk was 7%, risk ratio 7.2, while the excess risk was 18%, risk ratio 1.5 for women in their eighties. Having HF as a 60-year old man was associated with a five-year risk of death similar to a 75-year old man without HF. Further, HF was associated with an excess risk of non-HF hospitalization, ranging from 8% for patients >85 years to 30% for patients <30 years. Regardless of age, sex and comorbidity, HF was associated with excess risk of mortality and non-HF hospitalizations, but the relative risk ratio diminishes sharply with advancing age, which may influence allocation of resources for medical care across populations.