Clinical Trajectories and Long-Term Outcomes of Alcoholic Versus Other Forms of Dilated Cardiomyopathy

Amanda Fernandes*, Alan Manivannan, Morten Schou, Emil Fosbøl, Lars Køber, Finn Gustafsson, Gunnar H Gislason, Christian Torp-Pedersen, Charlotte Andersson*

*Corresponding author for this work
1 Citation (Scopus)


BACKGROUND: Alcoholic cardiomyopathy (ACM) is a form of dilated cardiomyopathy (DCM) occurring secondary to long-standing heavy alcohol use and is associated with poor outcomes, but the cause-specific risks are insufficiently understood.

METHOD: Between 1997 and 2018, we identified all patients with a first diagnosis of ACM or DCM. The cumulative incidence of different causes of hospitalisation and mortality in the two groups was calculated using the Fine-Gray and Kaplan-Meier methods.

RESULTS: A Total of 1,237 patients with ACM (mean age 56.3±10.1 years, 89% men) and 17,211 individuals with DCM (mean age 63.6±13.8 years, 71% men) were identified. Diabetes (10% vs 15%), hypertension (22% vs 31%), and stroke (8% vs 10%) were less common in ACM than DCM, whereas obstructive lung disease (15% vs 12%) and liver disease (17% vs 2%) were more prevalent (p<0.05). Cumulative 5-year mortality was 49% in ACM vs 33% in DCM, p<0.0001, multivariable adjusted hazards ratio 2.11 (95% confidence interval 1.97-2.26). The distribution of causes of death was similar in ACM and DCM, with the predominance of cardiovascular causes in both groups (42% in ACM vs 44% in DCM). 5-year cumulative incidence of heart failure hospitalisations (48% vs 54%) and any somatic cause (59% vs 65%) were also similar in ACM vs DCM. At 1 year, the use of beta blockers (55% vs 80%) and implantable cardioverter defibrillators (3% vs 14%) were significantly less often used in ACM vs DCM.

CONCLUSIONS: Patients with ACM had similar cardiovascular risks and hospitalisation patterns as other forms of DCM, but lower use of guideline-directed cardiovascular therapies and greater mortality.

Original languageEnglish
JournalHeart Lung and Circulation
Issue number3
Pages (from-to)368-375
Number of pages8
Publication statusPublished - Mar 2024


  • Alcoholic
  • Cardiomyopathy
  • Dilated
  • Prognosis
  • Cardiomyopathy, Alcoholic/diagnosis
  • Humans
  • Middle Aged
  • Male
  • Defibrillators, Implantable/adverse effects
  • Incidence
  • Cardiomyopathy, Dilated/diagnosis
  • Heart Failure
  • Female
  • Aged


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