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

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Informations de copyright

© 2024 Madelaire et al.

Déclaration de conflit d'intérêts

Professor Lars Køber reports personal fees from Speakers honorarium from Novo, Novartis, AstraZeneca and Boehringer, outside the submitted work. Professor Finn Gustafsson reports personal fees from Abbott, Novartis, Pfizer, AstraZeneca, Alnylam, and Bayer, outside the submitted work. Dr Søren Lund Kristensen reports personal fees from AstraZeneca, Bayer, outside the submitted work and is currently an employee of Novo Nordisk. Professor Christian Torp-Pedersen reports grants from Bayer and Novo Nordisk, during the conduct of the study. Professor Morten Schou reports lecture fees from Novo Nordisk, Novartis, AstraZeneca and Boehringer Ingelheim outside the submitted work. The authors report no other conflicts of interest in this work.