Clinical characteristics and outcomes of young and very young adults with heart failure: the CHARM programme

Wong, C.M. et al. (2013) Clinical characteristics and outcomes of young and very young adults with heart failure: the CHARM programme. Journal of the American College of Cardiology, 62(20), pp. 1845-1854. (doi: 10.1016/j.jacc.2013.05.072)

Abstract

<p>Objectives: To determine the characteristics and outcomes of young adults with heart failure (HF).</p> <p>Background: Few studies have focused on young and very young adults with HF.</p> <p>Methods: Patients were categorized into 5 age groups: 20-39, 40-49, 50-59, 60-69, and ≥70 years.</p> <p>Results: The youngest patients with HF were more likely to be obese (youngest vs. oldest: BMI≥35kg/m2: 23% vs. 6%), of black ethnicity (18% vs. 2%), and have idiopathic dilated cardiomyopathy (IDCM 62% vs. 9%) (all p<0.0001). They were less likely to adhere to medication (non-adherence 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 worst but all-cause mortality was lowest in the youngest age group (3 years mortality rates across the respective age categories: 12%, 13%, 13%, 19%, and 31%). Compared to the referent age group of 60-69 years, both all-cause and cardiovascular mortality were lower in the youngest group even after multivariable adjustment (respective HR 0.60 (0.36-1.00) [p=0.049] and 0.71 (0.42-1.18) [p=0.186]). Three-year HF hospitalisation rates were 24%, 15%, 15%, 22% and 28% in age categories 20-39, 40-49, 50-59, 60-69 and ≥70 years respectively (p<0.0001). Conclusion: Beyond divergent etiology and comorbidities, younger patients exhibit striking differences in presentation and outcomes compared with older counterparts. Clinical and radiological signs of HF are less common, yet quality of life more significantly impaired. Fatal and non-fatal outcomes are discordant, with better survival despite higher hospitalization rates.</p>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jhund, Professor Pardeep and Petrie, Professor Mark and McMurray, Professor John
• Authors: Wong, C.M., Hawkins, N.M., Jhund, P.S., MacDonald, M., Solomon, S.D., Granger, C.B., Yusuf, S., Pfeffer, M.A., Swedberg, K., Petrie, M.C., and McMurray, J.J.V.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of the American College of Cardiology
• Publisher: Elsevier Inc.
• ISSN: 0735-1097