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Clinical characteristics and outcomes of young and very young adults with heart failure: The CHARM programme (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity).

Publication ,  Journal Article
Wong, CM; Hawkins, NM; Jhund, PS; MacDonald, MR; Solomon, SD; Granger, CB; Yusuf, S; Pfeffer, MA; Swedberg, K; Petrie, MC; McMurray, JJV
Published in: J Am Coll Cardiol
November 12, 2013

OBJECTIVES: This study sought to determine the characteristics and outcomes of young adults with heart failure (HF). BACKGROUND: Few studies have focused on young and very young adults with HF. METHODS: Patients were categorized into 5 age groups: 20 to 39, 40 to 49, 50 to 59, 60 to 69, and ≥70 years. RESULTS: The youngest patients with HF were more likely to be obese (youngest vs. oldest: body mass index ≥35 kg/m(2): 23% vs. 6%), of black ethnicity (18% vs. 2%), and have idiopathic-dilated cardiomyopathy (62% vs. 9%) (all p < 0.0001). They were less likely to adhere to medication (nonadherence in youngest vs. oldest: 24% vs. 7%, p = 0.001), salt intake, and other dietary measures (21% vs. 9%, p = 0.002). The youngest patients were less likely to have clinical and radiological signs of HF during hospitalization. Quality of life was worse, but all-cause mortality was lowest in the youngest age group (3-year mortality rates across the respective age categories: 12%, 13%, 13%, 19%, and 31%, respectively). Compared with the referent age group of 60 to 69 years, both all-cause and cardiovascular mortality were lower in the youngest group even after multivariable adjustment (hazard ratio: 0.60, 95% confidence interval: 0.36 to 1.00; p = 0.049, and hazard ratio: 0.71, 95% confidence interval: 0.42 to 1.18, p = 0.186, respectively). Three-year HF hospitalization rates were 24%, 15%, 15%, 22%, and 28% in ages 20 to 39, 40 to 49, 50 to 59, 60 to 69, and ≥70 years, respectively (p < 0.0001). CONCLUSIONS: Beyond divergent etiology and comorbidities, younger patients exhibited striking differences in presentation and outcomes compared with older counterparts. Clinical and radiological signs of HF were less common, yet quality of life was more significantly impaired. Fatal and nonfatal outcomes were discordant, with better survival despite higher hospitalization rates.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

November 12, 2013

Volume

62

Issue

20

Start / End Page

1845 / 1854

Location

United States

Related Subject Headings

  • Young Adult
  • Tetrazoles
  • Stroke Volume
  • South Africa
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Quality of Life
  • North America
  • Middle Aged
  • Medication Adherence
 

Citation

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Wong, C. M., Hawkins, N. M., Jhund, P. S., MacDonald, M. R., Solomon, S. D., Granger, C. B., … McMurray, J. J. V. (2013). Clinical characteristics and outcomes of young and very young adults with heart failure: The CHARM programme (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity). J Am Coll Cardiol, 62(20), 1845–1854. https://doi.org/10.1016/j.jacc.2013.05.072
Wong, Chih M., Nathaniel M. Hawkins, Pardeep S. Jhund, Michael R. MacDonald, Scott D. Solomon, Christopher B. Granger, Salim Yusuf, et al. “Clinical characteristics and outcomes of young and very young adults with heart failure: The CHARM programme (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity).J Am Coll Cardiol 62, no. 20 (November 12, 2013): 1845–54. https://doi.org/10.1016/j.jacc.2013.05.072.
Wong, Chih M., et al. “Clinical characteristics and outcomes of young and very young adults with heart failure: The CHARM programme (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity).J Am Coll Cardiol, vol. 62, no. 20, Nov. 2013, pp. 1845–54. Pubmed, doi:10.1016/j.jacc.2013.05.072.
Wong CM, Hawkins NM, Jhund PS, MacDonald MR, Solomon SD, Granger CB, Yusuf S, Pfeffer MA, Swedberg K, Petrie MC, McMurray JJV. Clinical characteristics and outcomes of young and very young adults with heart failure: The CHARM programme (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity). J Am Coll Cardiol. 2013 Nov 12;62(20):1845–1854.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

November 12, 2013

Volume

62

Issue

20

Start / End Page

1845 / 1854

Location

United States

Related Subject Headings

  • Young Adult
  • Tetrazoles
  • Stroke Volume
  • South Africa
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Quality of Life
  • North America
  • Middle Aged
  • Medication Adherence