Heart failure in younger patients: the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC).

AIM: Our understanding of heart failure in younger patients is limited. The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) database, which consisted of 24 prospective observational studies and 7 randomized trials, was used to investigate the clinical characteristics, treatment, and outcomes of younger patients. METHODS AND RESULTS: Patients were stratified into six age categories: <40 (n = 876), 40-49 (n = 2638), 50-59 (n = 6894), 60-69 (n = 12 071), 70-79 (n = 13 368), and ≥80 years (n = 6079). Of 41 926 patients, 2.1, 8.4, and 24.8% were younger than 40, 50, and 60 years of age, respectively. Comparing young (<40 years) against elderly (≥80 years), younger patients were more likely to be male (71 vs. 48%) and have idiopathic cardiomyopathy (63 vs. 7%). Younger patients reported better New York Heart Association functional class despite more severe left ventricular dysfunction (median ejection fraction: 31 vs. 42%, all P < 0.0001). Comorbidities such as hypertension, myocardial infarction, and atrial fibrillation were much less common in the young. Younger patients received more disease-modifying pharmacological therapy than their older counterparts. Across the younger age groups (<40, 40-49, and 50-59 years), mortality rates were low: 1 year 6.7, 6.6, and 7.5%, respectively; 2 year 11.7, 11.5, 13.0%; and 3 years 16.5, 16.2, 18.2%. Furthermore, 1-, 2-, and 3-year mortality rates increased sharply beyond 60 years and were greatest in the elderly (≥80 years): 28.2, 44.5, and 57.2%, respectively. CONCLUSION: Younger patients with heart failure have different clinical characteristics including different aetiologies, more severe left ventricular dysfunction, and less severe symptoms. Three-year mortality rates are lower for all age groups under 60 years compared with older patients.

Relationship between angina pectoris and outcomes in patients with heart failure and reduced ejection fraction: an analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA).

AIM: Angina pectoris is common in patients with heart failure and reduced ejection fraction (HF-REF) but its relationship with outcomes has not been well defined. This relationship was investigated further in a retrospective analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). METHODS AND RESULTS: Four thousand, eight hundred and seventy-eight patients were divided into three categories: no history of angina and no chest pain at baseline (Group A; n = 1240), past history of angina but no chest pain at baseline (Group B; n = 1353) and both a history of angina and chest pain at baseline (Group C; n = 2285). Outcomes were examined using Kaplan-Meier and Cox regression survival analysis. Compared with Group A, Group C had a higher risk of non-fatal myocardial infarction or unstable angina (HR: 2.36, 1.54-3.61; P < 0.001), this composite plus coronary revascularization (HR: 2.54, 1.76-3.68; P < 0.001), as well as HF hospitalization (HR: 1.35, 1.13-1.63; P = 0.001), over a median follow-up period of 33 months. There was no difference in cardiovascular or all-cause mortality. Group B had a smaller increase in risk of coronary events but not of heart failure hospitalization. CONCLUSION: Patients with HF-REF and ongoing angina are at an increased risk of acute coronary syndrome and HF hospitalization. Whether these patients would benefit from more aggressive medical therapy or percutaneous revascularization is not known and merits further investigation.

Heart Failure in Young Adults Is Associated With High Mortality: A Contemporary Population-Level Analysis.

BACKGROUND: Data on young patients with heart failure (HF) are sparse. We examined the characteristics, health care use, and survival of younger vs older patients with HF. METHODS: We performed an analysis of linked administrative databases in Alberta, Canada. We identified 34,548 patients who had a first hospitalization for HF as the principal diagnosis from 2002-2014. Patients were stratified into 4 age groups: 20-44, 45-54, 55-64, and ≥ 65 years. RESULTS: Of the 34,548 patients, 496 (1.4%), 1319 (3.8%), 3359 (9.7%), and 29,374 (85%) were aged 20-44, 45-54, 55-64, and ≥ 65 years, respectively. The incidence of HF hospitalization decreased over time among patients ≥ 65 years and increased among men aged 20-64 years. In the year after the index HF hospitalization, compared with older patients, younger patients were less likely to present to the emergency department (ED) (eg, 67.2% of those aged 20-44 years vs 74.8% of those aged ≥ 65 years) or to be hospitalized for any reason (48.5% vs 61.2%), cardiovascular causes (28.6% vs 34.4%), or HF (14.8% vs 23.6%). Mortality rates were lower in younger patients aged 20-44 years but were still substantial: 3.9%, 12.4%, and 27.7% at 30 days, 1 year, and 5 years, respectively. CONCLUSIONS: Although young patients, especially those < 45 years of age, accounted for a small proportion of the total population, adverse events were frequent, with half of the younger patients being readmitted, two-thirds presenting to an ED, and > 10% dying within a year.

Clinical characteristics and outcomes of patients with angina and heart failure in the CHARM (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity) Programme.

AIMS: To investigate the relationship between angina pectoris and fatal and non-fatal clinical outcomes in heart failure with reduced and preserved ejection fraction (HF-REF and HF-PEF, respectively). METHODS AND RESULTS: Of 7599 patients in the CHARM program, 5408 had ischaemic heart disease; 3855 had HF-REF (ejection fraction ≤45%) and 1553 had HF-PEF. These patients were separated into three groups: no history of angina, previous angina, and current angina. Three coronary outcomes were examined: fatal or non-fatal myocardial infarction (MI); MI or hospitalization for unstable angina (UA); and MI, UA or coronary revascularization. The composite heart failure outcome of cardiovascular death or heart failure hospitalization (HFH) was also analysed, along with its components and all-cause mortality. New York Heart Association functional class was worse in both HF-REF and HF-PEF patients with current angina compared with patients without angina (P < 0.001 and P = 0.005 respectively), despite similar clinical examination findings and ejection fraction. Patients with current angina had a higher risk of all three coronary outcomes (adjusted hazard ratios ranging from 1.8-3.1) than those without angina but did not have a higher risk of heart failure outcomes or all-cause mortality. CONCLUSION: In patients with heart failure current angina is associated with significantly more functional limitation and a higher risk of coronary events, across the spectrum of left ventricular ejection fraction.

The ease of use and reproducibility of the Alere™ Heart Check System: a comparison of patient and healthcare professional measurement of BNP.

AIMS: The aim of the study was to examine the ease of use and the reproducibility of a novel point-of-care BNP measurement system when used by patients and healthcare providers (HCP). PATIENTS & METHODS: Patients with symptomatic heart failure were recruited from outpatient clinics at four hospitals. They were provided with brief training and instructional material for the use of the point-of-care BNP measurement system. Finger-prick blood BNP concentration was measured by the HCP and the patient (n = 150). Ease of use and reproducibility of the system were assessed. RESULTS: In total, 80% of the 164 patients who completed a questionnaire on the ease of use of the system found it easy to operate. There was excellent correlation of BNP measurement compared between patients and HCP (r = 0.966; p < 0.001). CONCLUSION: Patients find the Alere Heart Check BNP measurement system easy to operate. BNP concentration measurements obtained by patients show excellent correlation with those obtained by healthcare providers.

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).

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.