Influence of age on mechanisms and prognosis of heart failure

Background. Advanced age is commonly thought to carry a poor prognosis in congestive heart failure, but the case has not been established. The Department of Veterans Affairs Cooperative Vasodilator-Heart Failure Trials (V-HeFT I and II) provided a large data base to assess the effect of age on hemodynamic profiles and survival in the failing heart. Methods and Results. Patients were stratified into four categories according to age: ≤55, 56-60, 61-65, and >65 years. The distributions of treatments and baseline characteristics from history, physical findings, and laboratory data were analyzed for differences across age categories. Survival curves were calculated for age strata according to treatment, presence or absence of coronary artery disease, ejection fraction, and peak oxygen consumption. Risk ratios for age and treatment categories showed no consistent trend of treatment effect on mortality. Age was significantly associated with coronary artery disease, hypertension, rhythm disturbances, systolic blood pressure, ejection fraction, and peak oxygen uptake, but successive age strata did not show incremental changes. Survival curves did not show progressively steeper slopes with advancing age. In V-HeFT I, the oldest patients did have the poorest survival, but age interacted with the presence of coronary artery disease and randomization into the placebo group. Conclusions. Contrary to intuitive thinking, age alone did not shorten the survival in congestive heart failure patients who were <75 years old and receiving optimal therapy.