Abstract 10170: Mode of Death After Heart Failure Hospitalization in Elderly Patients

Introduction: Mode of death in heart failure (HF) patients varies by age. This study aimed to assess associations between cardiovascular (CV) and non-CV mortality with age among patients discharged after HF hospitalization using the competing risk analysis. Methods: From 2006 to 2017, 3558 consecutive patients enrolled in a prospective multicenter registry in Japan (the West Tokyo Heart Failure registry) were analyzed. The patients were categorized based on age and LVEF as follows: 1) <65 years (younger; LVEF ≥50% [n=182] and LVEF<50% [n=575]); 2) 65-84 years (elderly; LVEF ≥50% [n=894] and LVEF<50% [n=1159]); and 3) ≥85 years (very elderly; LVEF ≥50% [n=429] and LVEF<50% [n=319]). We evaluated the cumulative incidence of all-cause death and each mode of death after discharge. A Cox proportional hazards modeling was used with the Fine-Gray competing method. Results: During the median follow-up of 2.0 years, the incidence of all-cause death increased in parallel with increasing age categories. The Fine-Gray model demonstrated that LVEF was independently associated with risk of CV death (CVD) (adjusted subdistribution hazards ratio, 1.03; 95% confidence interval, 1.03-1.04, p<0.01). An enrichment in the proportional risk of CVD vs. non-CVD was also observed in patients with LVEF <50% even with increasing age categories: LVEF<50% (younger: 65.0%, elderly: 64.2%, very elderly: 55.6%) and LVEF ≥50% (younger: 50.0%, elderly: 41.2%, very elderly: 38.2%) (Figure). Conclusions: Mortality after HF hospitalization remains substantial in the contemporary era, particularly among elderly patients. Of note, the proportion of non-CVD increased with age, albeit CVDs still accounted for over half of deaths in patients with LVEF <50% in the patients within the oldest category.