Favorable five-year outcomes for heart failure diagnosed in younger patients without severe comorbidity

Background: Heart failure (HF) is widely associated with a median survival of 5 years. However, population level data on survival and HF progression has been limited for key subgroups. We assessed survival and HF progression, defined as hospitalization or outpatient diuretic intensification in patients ≤70 years without severe comorbidity, who received relevant medical therapy. Methods: From administrative registers, we identified all Danish patients ≤70 years diagnosed with HF 2000–2012 without severe comorbidity, survived for 120 days to receive angiotensin converting enzyme inhibitors (ACE-I)/angiotensin receptor blocker (ARB) and beta blocker. Risk of death or progression of HF was assessed with Kaplan-Meier and Aalen Johansen estimators, respectively. Cox regression models were used to identify factors associated with risk of death. Results: We included 19,985 patients, median age 61, 25% women - 1/3 of all HF patients ≤70 years. We excluded 237 patients who died within 120 days and 21,065 due to severe comorbidity. Five-year cumulative incidence of all-cause death was 14% (95%-confidence interval [CI]:13–14). Risk of death was increased for patients first diagnosed in hospital compared to outpatient clinics (hazard ratio: 1.51, 95%-CI:1.38–1.65, p < 0.001). Five-year cumulative incidence of HF hospitalization: 18% (95%-CI, 18–19) and intensification of diuretic therapy: 14% (95%-CI, 14–15). Conclusions: In patients ≤70 years without severe comorbidity, five-year mortality was only 14% and almost 2/3 were alive after 5 years without evident HF progression. Discussion of prognosis should be tailored to age and health status to provide realistic expectations for patients newly diagnosed and treated with recommended therapies for HF.