Abstract 13967: Clinical Epidemiology of Heart Failure With Preserved Ejection Fraction (HFpEF) in Comparatively Young Patients (< 65 years of age)
Background: HFpEF accounts for approximately half of all cases of HF. While HFpEF is primarily a disease of old age, its prevalence among younger patients is increasing, yet there is a paucity of data characterizing HFpEF in younger patients. The objective of this observational study was to characterize HFpEF in patients < 65 years of age in a typical community.
Methods: We reviewed the medical records of all 1,771 patients hospitalized with HFpEF (EF ≥ 50%) at 11 Massachusetts hospitals during 1995, 2000, 2002, and 2004, and followed mortality in these patients through 2009. We compared patient characteristics, presenting symptoms, medical history, laboratory and physiologic findings, treatments, and outcomes of younger (<65 years) versus older (≥65 years) patients.
Results: Of the 1,771 patients hospitalized with HFpEF, 280 (15%) were <65 years old. Compared to older patients, younger patients with HFpEF were significantly more likely to be male (43%, 32%), non-Caucasian (21%, 4%), and obese (60%, 31%), and to have a history of diabetes (46%, 32%) and chronic renal disease (27%, 22%). Younger patients were less likely to have a history of coronary disease (39%, 45%), hypertension (60%, 73%), or peripheral vascular disease (13%, 19%). Overall, younger patients with HFpEF received fewer cardiac medications (aspirin, beta blockers, calcium channel blockers) than older patients, though younger patients were more likely to receive statins. Length of stay (9.0 vs 7.4 mean days) and in-hospital mortality (7.5% vs 6.8%) were higher in younger patients, while postdischage mortality at 30 days (3.9% vs 6.8%) and 1 year (15% vs 27%) was higher in older patients.
Conclusion: While HFpEF is predominantly a disease of old age, its development in individuals less than 65 years old is strongly associated with multiple key comorbidities that may have predisposed them to HFpEF including morbid obesity, diabetes, renal insufficiency, and hypertension. Among younger patients hospitalized with HFpEF, in-hospital mortality was high. Our findings suggest that there may be different pathophysiologic mechanisms at play in the development of HFpEF in younger patients, as well as an important, unfulfilled clinical opportunity to more aggressively identify and treat these patients.
- © 2013 by American Heart Association, Inc.