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Impact of Age on Comorbidities and Outcomes in Heart Failure With Reduced Ejection Fraction.

Publication ,  Journal Article
Regan, JA; Kitzman, DW; Leifer, ES; Kraus, WE; Fleg, JL; Forman, DE; Whellan, DJ; Wojdyla, D; Parikh, K; O'Connor, CM; Mentz, RJ
Published in: JACC Heart Fail
December 2019

OBJECTIVES: This study sought to determine whether age modifies the impact of key comorbidities on clinical outcomes for patients with heart failure with reduced ejection fraction (HFrEF). BACKGROUND: Comorbidities impact outcomes in HFrEF. However, the effect of age on the impact of comorbidities on prognosis is not clearly understood. METHODS: Cox proportional hazards models were used assessed interactions between age and comorbidities on the primary composite endpoint (all-cause mortality or hospitalization) and secondary endpoints in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) multicenter trial of 2,331 patients with HFrEF. RESULTS: Age did not significantly modify the effect of any comorbidity on the primary endpoint. However, age significantly modified the effect of body mass index (BMI) on all-cause mortality (interaction p = 0.02). Among patients ≥70 years of age, there was a U-shaped relationship between BMI and 1-year mortality, where BMI of 20 kg/m2 corresponded to 17.6%; a BMI of 30 kg/m2 corresponded to 7.0%; and a BMI of 40 kg/m2 corresponded to 11%. For patients <60 years of age, mortality increased nonsignificantly from 3.2% to 3.7% with increasing BMI. Age also modified the effect of depressive symptoms on all-cause mortality (interaction p = 0.03). Among patients ≥70 years of age, a 1-year mortality rate significantly increased from 7.8% for a Beck Depression Inventory (BDI) score of 5% to 15.6% for BDI of 20. For patients <60 years of age, mortality was nonsignificantly related to BDI. Cumulative comorbidity scores were stronger predictors than age for mortality/hospitalization. CONCLUSIONS: In chronic HFrEF, age markedly altered the impact of BMI and depressive symptoms on all-cause mortality, with much higher risk in older patients, but was not as strong a predictor of mortality/hospitalizations as cumulative comorbidity score. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437).

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

December 2019

Volume

7

Issue

12

Start / End Page

1056 / 1065

Location

United States

Related Subject Headings

  • Stroke Volume
  • Prognosis
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
  • Cause of Death
  • Aged
 

Citation

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Regan, J. A., Kitzman, D. W., Leifer, E. S., Kraus, W. E., Fleg, J. L., Forman, D. E., … Mentz, R. J. (2019). Impact of Age on Comorbidities and Outcomes in Heart Failure With Reduced Ejection Fraction. JACC Heart Fail, 7(12), 1056–1065. https://doi.org/10.1016/j.jchf.2019.09.004
Regan, Jessica A., Dalane W. Kitzman, Eric S. Leifer, William E. Kraus, Jerome L. Fleg, Daniel E. Forman, David J. Whellan, et al. “Impact of Age on Comorbidities and Outcomes in Heart Failure With Reduced Ejection Fraction.JACC Heart Fail 7, no. 12 (December 2019): 1056–65. https://doi.org/10.1016/j.jchf.2019.09.004.
Regan JA, Kitzman DW, Leifer ES, Kraus WE, Fleg JL, Forman DE, et al. Impact of Age on Comorbidities and Outcomes in Heart Failure With Reduced Ejection Fraction. JACC Heart Fail. 2019 Dec;7(12):1056–65.
Regan, Jessica A., et al. “Impact of Age on Comorbidities and Outcomes in Heart Failure With Reduced Ejection Fraction.JACC Heart Fail, vol. 7, no. 12, Dec. 2019, pp. 1056–65. Pubmed, doi:10.1016/j.jchf.2019.09.004.
Regan JA, Kitzman DW, Leifer ES, Kraus WE, Fleg JL, Forman DE, Whellan DJ, Wojdyla D, Parikh K, O’Connor CM, Mentz RJ. Impact of Age on Comorbidities and Outcomes in Heart Failure With Reduced Ejection Fraction. JACC Heart Fail. 2019 Dec;7(12):1056–1065.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

December 2019

Volume

7

Issue

12

Start / End Page

1056 / 1065

Location

United States

Related Subject Headings

  • Stroke Volume
  • Prognosis
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
  • Cause of Death
  • Aged