Heart failure with preserved ejection fraction shows no excess mortality in older patients: a population-matched relative survival analysis

Both heart failure with preserved ejection fraction (HFpEF) and advanced age are associated with increased mortality. However, HFpEF patients have not been compared with a similar age group from the general population. This study aimed to compare the mortality of HFpEF patients with an age- and gender-matched population, for two age groups (< 80 years and ≥ 80 years). Real-life cohort study of HFpEF patients with complete cardiac assessments carried out at an academic hospital since 2015. The observed mortality rates of the two age groups were compared to the expected mortality rate, using standardised mortality ratios (SMR). Of 334 HFpEF patients (mean age 79 ± 8.2 years, 64% women), 166 (50%) were ≥ 80 years. Older patients ≥ 80 years, compared to younger ones, had more frequently atrial fibrillation (73% vs. 61%), chronic kidney disease (67% vs. 53%), but less diabetes (24% vs. 45%), and lower BMI. During the follow-up (median: 4.1 years), 108 patients (32%) died. Compared to an age- and gender- matched population, HFpEF patients < 80 years had a three times higher mortality risk (SMR 3.37, 95% CI: 2.4-4.7), while HFpEF patients ≥ 80 years had a similar mortality risk (SMR 1.13, 95% CI:0.84-1.15). Consistently, no excess mortality was observed in the older patient group. Excess mortality is observed in HFpEF patients < 80 years but not in patients ≥ 80 years. This unexpected divergence likely reflects distinct HFpEF phenotypes and demographics across age groups. This trial was registered on 4 December 2014 at ClinicalTrials.gov (NCT03197350).