Abstract 4363840: Clinical Characteristics of Idiopathic Cardiomyopathy After Optimal Medical Therapy in Working-Age Patients in a Regional Community Hospital

Background: Our hospital is the only acute care facility in the Nishu district (population ~64,000), enabling comprehensive capture of heart failure (HF) hospitalizations. Idiopathic cardiomyopathy is a known HF cause, but its clinical course after optimal medical therapy (OMT) in working-age adults remains poorly documented. Social isolation and adverse work conditions are increasingly linked to cardiovascular risk, yet real-world data are limited. We analyzed idiopathic cardiomyopathy in hospitalized working-age HF patients after OMT. Methods: Patients aged 40–65 hospitalized for new-onset HF between January 1998 and June 2024 were retrospectively enrolled. Secondary cardiomyopathies and non-residents were excluded. HF classification and cardiac function were assessed during outpatient follow-up starting January 2025. Results: Fifty-six patients met the criteria. Of these, 41 (73.2%) were classified as HF with improved ejection fraction (HFimpEF), 7 (12.5%) as HFrEF, 3 each (5.4%) as HFpEF and HFmrEF. In the HFimpEF group, 90.2% were male, 68.3% unmarried, and 80.5% had adverse social backgrounds (e.g., harsh work conditions, unemployment, alcohol dependence, psychiatric illness). Overall, 92.7% had at least one social vulnerability. Hypertension, diabetes, and obesity were present in 21, 22, and 24 patients, respectively. Six HFimpEF patients had recurrence; all were unmarried with social adversity, and 3 were non-adherent to therapy. In the HFrEF group, only 3 had social risks (P = 0.0045), while 4 were poorly adherent. Four patients were diagnosed with dilated cardiomyopathy (DCM); none had major social issues, yet their disease progressed despite OMT. Conclusion: Most idiopathic cardiomyopathy cases in this working-age group presented as HFimpEF and were seen in socially vulnerable men. Although prognosis was generally good with OMT, social adversity appeared to contribute significantly to HF onset. In contrast, DCM patients lacked social risk but had worse outcomes, suggesting different pathophysiological mechanisms. Social factors should be addressed in HF prevention and care strategies.