Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study

Caroline Hartwell Garred; Morten Malmborg; Mariam Elmegaard Malik; Deewa Zahir; Daniel Mølager Christensen; Anojhaan Arulmurugananthavadivel; Emil L Fosbøl; Gunnar Gislason; John J V McMurray; Mark C Petrie; Charlotte Andersson; Lars Køber; Morten Schou

doi:10.1016/S2666-7568(24)00029-1

Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study

Caroline Hartwell Garred, Morten Malmborg, Mariam Elmegaard Malik, Deewa Zahir, Daniel Mølager Christensen, Anojhaan Arulmurugananthavadivel, Emil L Fosbøl, Gunnar Gislason, John J V McMurray, Mark C Petrie, Charlotte Andersson, Lars Køber, Morten Schou

Abstract

BACKGROUND: Despite advances in heart failure care reducing mortality in clinical trials, it remains unclear whether real-life cohorts have had similar improvements in life expectancy across the age spectrum. We aimed to investigate how mortality trends changed in patients with heart failure over the past 25 years, stratified by age groups.

METHODS: Using Danish nationwide registries, we identified patients with new-onset heart failure aged 18-95 years. The 5-year all-cause mortality risk and the absolute risk difference of mortality between patients with heart failure and age-matched and sex-matched heart failure-free controls were assessed using Kaplan-Meier estimates and multivariable Cox regression models. Mortality trends were analysed across five calendar periods (1996-2000, 2001-05, 2006-10, 2011-15, and 2016-20) and three age groups (<65 years, 65-79 years, and ≥80 years).

FINDINGS: 194 997 patients with heart failure were included. Mortality significantly decreased from 1996-2000 (66% [95% CI 65·5-66·4]) to 2016-20 (43% [42·1-43·4]), with similar results shown in all age groups (<65 years: 35% [33·9-36·1] to 15% [14·6-16·3]; 65-79 years: 64% [63·1-64·5] to 39% [37·6-39·6]; and ≥80 years: 84% [83·1-84·3] to 73% [71·7-73·9]). Adjusted mortality rates supported these associations. The absolute risk difference declined notably in younger age groups (<65 years: 29·9% [28·8-31·0] to 12·7% [12·0-13·4] and 65-79 years: 41·1% [40·3-41·9] to 25·1% [24·4-25·8]), remaining relatively stable in those aged 80 years or older (30·6% [29·9-31·3] to 28% [27·2-28·8]).

INTERPRETATION: Over 25 years, there has been a consistent decrease in mortality among patients with heart failure across age groups, albeit less prominently in patients aged 80 years or older. Further insight is needed to identify effective strategies for improving disease burden in older patients with heart failure.

FUNDING: None.

TRANSLATION: For the Danish translation of the abstract see Supplementary Materials section.

Original language	English
Journal	The Lancet Healthy Longevity
Volume	5
Issue number	5
Pages (from-to)	e326-e335
ISSN	2666-7568
DOIs	https://doi.org/10.1016/S2666-7568(24)00029-1
Publication status	Published - May 2024

Keywords

Humans
Heart Failure/mortality
Aged
Denmark/epidemiology
Male
Female
Middle Aged
Adult
Aged, 80 and over
Retrospective Studies
Adolescent
Young Adult
Age Factors
Registries

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Garred, C. H., Malmborg, M., Malik, M. E., Zahir, D., Christensen, D. M., Arulmurugananthavadivel, A., Fosbøl, E. L., Gislason, G., McMurray, J. J. V., Petrie, M. C., Andersson, C., Køber, L., & Schou, M. (2024). Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study. The Lancet Healthy Longevity, 5(5), e326-e335. https://doi.org/10.1016/S2666-7568(24)00029-1

Garred, CH, Malmborg, M, Malik, ME , Zahir, D, Christensen, DM, Arulmurugananthavadivel, A, Fosbøl, EL , Gislason, G, McMurray, JJV, Petrie, MC, Andersson, C, Køber, L & Schou, M 2024, 'Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study', The Lancet Healthy Longevity, vol. 5, no. 5, pp. e326-e335. https://doi.org/10.1016/S2666-7568(24)00029-1

@article{90f66c4e146947ca80b25e95def54f3f,

title = "Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study",

abstract = "BACKGROUND: Despite advances in heart failure care reducing mortality in clinical trials, it remains unclear whether real-life cohorts have had similar improvements in life expectancy across the age spectrum. We aimed to investigate how mortality trends changed in patients with heart failure over the past 25 years, stratified by age groups.METHODS: Using Danish nationwide registries, we identified patients with new-onset heart failure aged 18-95 years. The 5-year all-cause mortality risk and the absolute risk difference of mortality between patients with heart failure and age-matched and sex-matched heart failure-free controls were assessed using Kaplan-Meier estimates and multivariable Cox regression models. Mortality trends were analysed across five calendar periods (1996-2000, 2001-05, 2006-10, 2011-15, and 2016-20) and three age groups (<65 years, 65-79 years, and ≥80 years).FINDINGS: 194 997 patients with heart failure were included. Mortality significantly decreased from 1996-2000 (66% [95% CI 65·5-66·4]) to 2016-20 (43% [42·1-43·4]), with similar results shown in all age groups (<65 years: 35% [33·9-36·1] to 15% [14·6-16·3]; 65-79 years: 64% [63·1-64·5] to 39% [37·6-39·6]; and ≥80 years: 84% [83·1-84·3] to 73% [71·7-73·9]). Adjusted mortality rates supported these associations. The absolute risk difference declined notably in younger age groups (<65 years: 29·9% [28·8-31·0] to 12·7% [12·0-13·4] and 65-79 years: 41·1% [40·3-41·9] to 25·1% [24·4-25·8]), remaining relatively stable in those aged 80 years or older (30·6% [29·9-31·3] to 28% [27·2-28·8]).INTERPRETATION: Over 25 years, there has been a consistent decrease in mortality among patients with heart failure across age groups, albeit less prominently in patients aged 80 years or older. Further insight is needed to identify effective strategies for improving disease burden in older patients with heart failure.FUNDING: None.TRANSLATION: For the Danish translation of the abstract see Supplementary Materials section.",

keywords = "Humans, Heart Failure/mortality, Aged, Denmark/epidemiology, Male, Female, Middle Aged, Adult, Aged, 80 and over, Retrospective Studies, Adolescent, Young Adult, Age Factors, Registries",

author = "Garred, {Caroline Hartwell} and Morten Malmborg and Malik, {Mariam Elmegaard} and Deewa Zahir and Christensen, {Daniel M{\o}lager} and Anojhaan Arulmurugananthavadivel and Fosb{\o}l, {Emil L} and Gunnar Gislason and McMurray, {John J V} and Petrie, {Mark C} and Charlotte Andersson and Lars K{\o}ber and Morten Schou",

year = "2024",

month = may,

doi = "10.1016/S2666-7568(24)00029-1",

language = "English",

volume = "5",

pages = "e326--e335",

journal = "The Lancet Healthy Longevity",

issn = "2666-7568",

publisher = "Elsevier",

number = "5",

}

TY - JOUR

T1 - Age-specific mortality trends in heart failure over 25 years

T2 - a retrospective Danish nationwide cohort study

AU - Garred, Caroline Hartwell

AU - Malmborg, Morten

AU - Malik, Mariam Elmegaard

AU - Zahir, Deewa

AU - Christensen, Daniel Mølager

AU - Arulmurugananthavadivel, Anojhaan

AU - Fosbøl, Emil L

AU - Gislason, Gunnar

AU - McMurray, John J V

AU - Petrie, Mark C

AU - Andersson, Charlotte

AU - Køber, Lars

AU - Schou, Morten

PY - 2024/5

Y1 - 2024/5

N2 - BACKGROUND: Despite advances in heart failure care reducing mortality in clinical trials, it remains unclear whether real-life cohorts have had similar improvements in life expectancy across the age spectrum. We aimed to investigate how mortality trends changed in patients with heart failure over the past 25 years, stratified by age groups.METHODS: Using Danish nationwide registries, we identified patients with new-onset heart failure aged 18-95 years. The 5-year all-cause mortality risk and the absolute risk difference of mortality between patients with heart failure and age-matched and sex-matched heart failure-free controls were assessed using Kaplan-Meier estimates and multivariable Cox regression models. Mortality trends were analysed across five calendar periods (1996-2000, 2001-05, 2006-10, 2011-15, and 2016-20) and three age groups (<65 years, 65-79 years, and ≥80 years).FINDINGS: 194 997 patients with heart failure were included. Mortality significantly decreased from 1996-2000 (66% [95% CI 65·5-66·4]) to 2016-20 (43% [42·1-43·4]), with similar results shown in all age groups (<65 years: 35% [33·9-36·1] to 15% [14·6-16·3]; 65-79 years: 64% [63·1-64·5] to 39% [37·6-39·6]; and ≥80 years: 84% [83·1-84·3] to 73% [71·7-73·9]). Adjusted mortality rates supported these associations. The absolute risk difference declined notably in younger age groups (<65 years: 29·9% [28·8-31·0] to 12·7% [12·0-13·4] and 65-79 years: 41·1% [40·3-41·9] to 25·1% [24·4-25·8]), remaining relatively stable in those aged 80 years or older (30·6% [29·9-31·3] to 28% [27·2-28·8]).INTERPRETATION: Over 25 years, there has been a consistent decrease in mortality among patients with heart failure across age groups, albeit less prominently in patients aged 80 years or older. Further insight is needed to identify effective strategies for improving disease burden in older patients with heart failure.FUNDING: None.TRANSLATION: For the Danish translation of the abstract see Supplementary Materials section.

AB - BACKGROUND: Despite advances in heart failure care reducing mortality in clinical trials, it remains unclear whether real-life cohorts have had similar improvements in life expectancy across the age spectrum. We aimed to investigate how mortality trends changed in patients with heart failure over the past 25 years, stratified by age groups.METHODS: Using Danish nationwide registries, we identified patients with new-onset heart failure aged 18-95 years. The 5-year all-cause mortality risk and the absolute risk difference of mortality between patients with heart failure and age-matched and sex-matched heart failure-free controls were assessed using Kaplan-Meier estimates and multivariable Cox regression models. Mortality trends were analysed across five calendar periods (1996-2000, 2001-05, 2006-10, 2011-15, and 2016-20) and three age groups (<65 years, 65-79 years, and ≥80 years).FINDINGS: 194 997 patients with heart failure were included. Mortality significantly decreased from 1996-2000 (66% [95% CI 65·5-66·4]) to 2016-20 (43% [42·1-43·4]), with similar results shown in all age groups (<65 years: 35% [33·9-36·1] to 15% [14·6-16·3]; 65-79 years: 64% [63·1-64·5] to 39% [37·6-39·6]; and ≥80 years: 84% [83·1-84·3] to 73% [71·7-73·9]). Adjusted mortality rates supported these associations. The absolute risk difference declined notably in younger age groups (<65 years: 29·9% [28·8-31·0] to 12·7% [12·0-13·4] and 65-79 years: 41·1% [40·3-41·9] to 25·1% [24·4-25·8]), remaining relatively stable in those aged 80 years or older (30·6% [29·9-31·3] to 28% [27·2-28·8]).INTERPRETATION: Over 25 years, there has been a consistent decrease in mortality among patients with heart failure across age groups, albeit less prominently in patients aged 80 years or older. Further insight is needed to identify effective strategies for improving disease burden in older patients with heart failure.FUNDING: None.TRANSLATION: For the Danish translation of the abstract see Supplementary Materials section.

KW - Humans

KW - Heart Failure/mortality

KW - Aged

KW - Denmark/epidemiology

KW - Male

KW - Female

KW - Middle Aged

KW - Adult

KW - Aged, 80 and over

KW - Retrospective Studies

KW - Adolescent

KW - Young Adult

KW - Age Factors

KW - Registries

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U2 - 10.1016/S2666-7568(24)00029-1

DO - 10.1016/S2666-7568(24)00029-1

M3 - Journal article

C2 - 38705151

SN - 2666-7568

VL - 5

SP - e326-e335

JO - The Lancet Healthy Longevity

JF - The Lancet Healthy Longevity

IS - 5

ER -

Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study

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