Effect of age on 5-year excess mortality in heart failure with reduced ejection fraction

Heart failure with reduced ejection fraction (HFrEF) is associated with increased mortality. However, the impact of age on excess mortality among patients with HFrEF remains unclear.

To assess the effect of age on excess mortality in patients with HFrEF.

We included patients aged 40 to 85 years with a left ventricular ejection fraction of ≤40% who underwent coronary angiography for suspected cardiomyopathy in Western Denmark between 2010 and 2021. Each patient was matched by sex and age with up to five individuals from the Danish general population. Excess mortality was examined by 5-year mortality risk differences and hazard ratios (HRs) across different age groups.

Among 5,425 patients with HFrEF and 27,087 matched controls, 5-year excess mortality was lowest in patients aged 40 to 49 years (6.8%, 95% CI: 4.0-9.7) and highest in those aged 65 to 69 years (17.0%, 95% CI: 13.8-20.2). In contrast, the highest relative risk was observed in those aged 40 to 49 years (HR: 6.41, 95% CI: 3.73-11.05), with a decline as age increased. A 10% 5-year mortality was reached at age 50 in patients with HFrEF, and at age 70 in controls.

HFrEF was associated with excess mortality across all age groups. Younger HFrEF patients had similar 5-year mortality as general population controls who were more than 20 years older.