To investigate the effect of aging on clinical features and prognosis of patients with heart failure (HF).

A retrospective cohort study was performed to collect data at Tianjin Medical University General Hospital and Tianjin Chest Hospital from March 2014 to February 2016. A total of 1747 patients with complete data were followed for 2-year outcome events. These patients mainly had HF and New York Heart Association (NYHA) cardiac function classificationⅡ-Ⅳ. They were categorized into three groups based on age: 650 cases in a non-elderly group (age<65 years), 718 cases in a young elderly group (aged 65-79 years), and 379 cases in an old elderly group (age≥80 years). The effects of aging on clinical features and prognosis of HF patients were analyzed.

In the non-elderly, young elderly, and old elderly groups, the percentages of male patients decreased gradually (74.9%, 59.2%, and 55.1%, respectively, χ²=53.85, P<0.001), the percentage of patients with heart failure with reduced ejection fraction (HFrEF) also declined gradually (49.2%, 39.8%, and 34.6%, respectively, χ²=23.88, P<0.001), the percentage of patients with heart failure with preserved ejection fraction (HFpEF) increased gradually (23.2%, 32.3%, and 37.7%, respectively, χ²=26.73, P<0.001), the percentage of patients with heart failure with mid-range ejection fraction (HFmrEF) was comparable (27.5%, 27.9%, and 27.7%, P>0.05), the percentage of NYHAⅣ HF patients increased gradually (19.5%, 27.7%, and 53.3%, χ²=133.02, P<0.001), the number of comorbidities in HF patients significantly increased (3.1, 3.6, and 4.0, P<0.001), and the average length of hospitalization days significantly became longer (P<0.05). The HF patients were followed for 2-year outcome events. All-cause mortality rate (19.1%, 32.6%, and 44.1%, P<0.001), recurrent HF hospitalization (20.5%, 27.7%, and 33.5%, P<0.001), and the occurrence rate of composite endpoint increased gradually (32.8%, 47.1%, and 63.1%, P<0.001) in the non-elderly, young elderly, and old elderly groups. In contrast with the non-elderly group, the hazard ratios (HRs) of all-cause mortality in the young elderly and old elderly groups were 1.81 (95%CI: 1.45-2.25) and 1.67 (95%CI: 1.49-1.88); the HRs of HF hospitalization were 1.41 (95%CI: 1.13-1.75) and 1.34 (95%CI: 1.18-1.51); and the HRs of occurrence of composite endpoint were 1.54 (95%CI: 1.30-1.83) and 1.53 (95%CI: 1.39-1.68), respectively.

The proportions of male patients with HF and HFrEF patients gradually decrease and the percentage of HFpEF patients gradually increases with aging. With aging, HF patients have more comorbidities, worse cardiac function, and longer hospital stay, and the risk of all-cause mortality, HF readmission, and composite endpoint events in 2 years is higher.