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. T he Department of Veterans Affairs Cooperative Vasodilator-Heart Failur e Trials (V-HeFT I and II) provided a large data base to assess the ef fect of age on hemodynamic profiles and survival in the failing heart. Methods and Results. Patients were stratified into four categories ac cording to age: less-than-or-equal-to 55, 56-60, 61-65, and >65 years. The distributions of treatments and baseline characteristics from his tory, physical findings, and laboratory data were analyzed for differe nces across age categories. Survival curves were calculated for age st rata according to treatment, presence or absence of coronary artery di sease, 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 ar tery disease, hypertension, rhythm disturbances, systolic blood pressu re, ejection fraction, and peak oxygen uptake, but successive age stra ta did not show incremental changes. Survival curves did not show prog ressively steeper slopes with advancing age. In V-HeFT I, the oldest p atients did have the poorest survival, but age interacted with the pre sence of coronary artery disease and randomization into the placebo gr oup. Conclusions. Contrary to intuitive thinking, age alone did not sh orten the survival in congestive heart failure patients who were <75 y ears old and receiving optimal therapy.