Clinical phenotype and treatment patterns according to age in patients hospitalised for heart failure

Background

Heart failure is a heterogeneous clinical syndrome whose burden has increased due to population ageing. Age may influence clinical presentation, underlying cause, cardiac structure and treatment decisions. However, real-world data comparing younger and older patients remain limited.

Objective

To compare clinical characteristics, echocardiographic findings, treatment patterns and outcomes in patients hospitalised for acute heart failure according to age.

Methods

This observational analytical study included 446 consecutive patients admitted for acute heart failure between 2020 and 2025. Patients were divided into two groups: younger than 75 years (n=172; 38.6%) and 75 years or older (n=274; 61.4%). The study analysed clinical variables, laboratory results, echocardiographic findings and pharmacological treatment during hospitalisation and at discharge. Outcomes included readmission for heart failure, cardiovascular mortality and length of hospital stay. Statistical significance was defined as a p value below 0.05.

Results

Patients aged 75 years or older were more frequently women (41.6% versus 31.4%; p=0.030) and showed a higher prevalence of arterial hypertension (83.2% versus 70.3%; p=0.001), chronic kidney disease (35.0% versus 24.4%; p=0.018) and atrial fibrillation (58.8% versus 38.4%; p<0.001). This group also showed a higher prevalence of hypertensive cardiomyopathy and cardiac amyloidosis.

Younger patients more often had a history of smoking (39.1% versus 28.1%; p=0.017) and alcohol consumption (13.0% versus 4.8%; p=0.002). They also more frequently presented with signs of low cardiac output at admission and dilated cardiomyopathy (40.1% versus 17.9%; p<0.001).

Echocardiography showed greater left ventricular dilatation (69.2% versus 41.2%; p<0.001), lower left ventricular ejection fraction (median 35% versus 50%; p<0.001) and a higher prevalence of restrictive diastolic dysfunction in younger patients. Older patients had higher levels of B-type natriuretic peptide (p=0.036) and creatinine (p<0.001) at discharge.

At discharge, younger patients received disease-modifying therapy more frequently, including beta-blockers, mineralocorticoid receptor antagonists and sacubitril with valsartan (all p<0.001). Older patients received these treatments less often, in parallel with lower diastolic blood pressure (p<0.001) and heart rate (p=0.001). Cardiovascular mortality (p=0.126) and time to heart failure readmission (p=0.235) did not differ significantly between groups, although older patients showed a trend towards earlier events.

Conclusions

Age strongly influences the clinical phenotype, underlying cause, cardiac structure and treatment of patients hospitalised for heart failure. Despite similar outcomes, older patients receive disease-modifying therapies less frequently. These findings highlight the need to improve guideline implementation and optimise heart failure management in elderly patients.TABLE IMAGEFor image description, please refer to the figure legend and surrounding text.KAPLAN-MEIER IMAGEFor image description, please refer to the figure legend and surrounding text.