Heart Failure With Preserved Ejection Fraction in the Young

Area of Science:

• Cardiology
• Gerontology
• Public Health

Background:

• Heart failure with preserved ejection fraction (HFpEF) is typically seen in older individuals.
• The characteristics and outcomes of HFpEF in younger populations remain understudied.
• This study investigates HFpEF in individuals under 65 years old.

Purpose of the Study:

• To characterize HFpEF in younger patient groups.
• To compare clinical and echocardiographic features, quality of life, and outcomes across different age strata of HFpEF patients.
• To compare very young HFpEF patients with age- and sex-matched controls.

Main Methods:

• Prospective enrollment of 1203 HFpEF patients (ejection fraction ≥50%) from 11 Asian regions.
• Classification into age groups: very young (<55), young (55-64), older (65-74), and elderly (≥75).
• Comparison of clinical data, echocardiography, quality of life, and 1-year outcomes; comparison of very young HFpEF with controls.

Main Results:

• 37% of HFpEF patients were under 65; this group showed male preponderance, higher obesity rates (36% vs. 16%), and less renal impairment, atrial fibrillation, and hypertension.
• Left ventricular filling pressures and hypertrophy prevalence were similar between very young and elderly HFpEF patients.
• Very young HFpEF patients had better quality of life and lower 1-year death/hospitalization rates (7%) than elderly HFpEF patients (21%), but a 3-fold higher death rate than controls.

Conclusions:

• Younger HFpEF patients exhibit similar adverse cardiac remodeling to older patients.
• HFpEF in the young is associated with significantly poorer outcomes compared to controls without heart failure.
• Obesity is identified as a potential major contributor to HFpEF in younger individuals.