Patient Characteristics and Mortality Trends Among Octogenarians With Heart Failure: A Real-World Analysis

BACKGROUND: It is uncertain whether recent advances in heart failure (HF) management have translated into improved survival among the very elderly.

OBJECTIVES: The objective of the study was to examine 20-year trends in 2-year mortality among Danish octogenarians with new-onset HF and identify-associated factors.

METHODS: This nationwide cohort study included all Danish patients aged ≥80 years diagnosed with incident HF from 2002 to 2021. Two-year mortality rates were assessed overall and across subgroups defined by age (≥85 years), sex, frailty, and comorbidities. Use of evidence-based HF therapies-angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor-neprilysin inhibitors, β-blockers, and mineralocorticoid receptor antagonists-was evaluated over time.

RESULTS: Among 46,943 octogenarians with incident HF, the crude 2-year mortality risk declined by 8% from 2002 to 2006 to 2017 to 2021. Adjusted analysis showed a 28% reduction in the hazard of mortality in the later period compared to the earlier period. Diagnoses increasingly occurred in outpatient settings, and patients had more recorded comorbidities over time. Mortality improvements were observed across all subgroups, although with variable magnitude. Use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors, and β-blockers increased, whereas mineralocorticoid receptor antagonists use slightly declined (2002-2006: 31.6%; 95% CI: 30.7%-32.5%; 2017-2021: 27.4%; 95% CI: 26.6%-28.3%).

CONCLUSIONS: Over the past 2 decades, 2-year mortality rates in octogenarians with HF have improved despite an increase in comorbidities recorded at the time of diagnosis.