TOPLINE:

Patients aged 40-85 years with heart failure with reduced ejection fraction (HFrEF) died at higher rates over 5 years than matched peers from the general population across all age groups; however, the greatest relative impact was seen in younger adults (aged 40-49 years).

METHODOLOGY:

• Researchers conducted an observational cohort study using linked Danish registries to examine how age affected the risk for excess mortality in patients aged 40-85 years with HFrEF.
• They included 5425 patients with a left ventricular ejection fraction of 40% or less who underwent coronary angiography for suspected cardiomyopathy between 2010 and 2021. Patients were matched by sex and age with 27,087 control individuals from the general population; the median age for both groups was 67 years, and 72% were men.
• Participants were categorised into eight age brackets ranging from 40-49 years to 80 years or older. Excess mortality was calculated as the difference between the proportion of patients and that of control individuals who died within 5 years.
• Researchers assessed all-cause mortality across the age groups over 5 years, with follow-up starting 30 days after coronary angiography to exclude procedure-related deaths.

TAKEAWAY:

• Overall, 24.6% of patients vs 11.2% of control individuals died within 5 years, with an excess mortality of 13.4% (hazard ratio [HR], 2.43; 95% CI, 2.26-2.61).
• Excess mortality increased from 6.8% in the 40-49 age group to a peak of 17.0% in the 65-69 age group and decreased to 13.2% in those aged 80 years or older. However, the 40-49 age group had the highest relative risk compared with control peers (HR, 6.41; 95% CI, 3.73-11.05).
• Patients reached a 5-year mortality threshold of 10% at the age of 50 years, whereas control individuals reached the same only at the age of 70 years — a 20-year difference.
• Patients with coronary artery disease had higher 5‑year mortality than those without the condition (30.5% vs 18.5%) and greater excess mortality. Overall excess mortality was similar for men and women, although men had slightly higher 5‑year mortality in older age groups.

IN PRACTICE:

"[The study] finding supports a proactive clinical approach in younger patients with HFrEF, including early optimisation of guideline-recommended medical treatment, timely evaluation for device-based interventions such as ICD [implantable cardioverter defibrillator] implantation, and sustained long-term follow-up," the researchers of the study wrote.

SOURCE:

This study was led by Nina Stødkilde-Jørgensen, MD, Aarhus University Hospital, Aarhus, Denmark. It was published online on March 26, 2026, in the European Journal of Heart Failure.

LIMITATIONS:

The study was conducted in a relatively low-risk Danish population, which may have limited the generalisability of the findings to countries at a higher cardiovascular risk. The study included only patients with HFrEF who underwent coronary angiography, which may have introduced selection bias and limited broader applicability. Data on heart failure aetiology were unavailable.

DISCLOSURES:

This study received funding through a grant from the Novo Nordisk Foundation. Two authors disclosed receiving grants from the funding source and/or Danish Cardiovascular Academy. One of them reported receiving lecture and/or advisory board fees and having ongoing research contracts and minor shareholder equity positions in the industry, including the funding source.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.