African Americans, obese overrepresented in young heart failure cases

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1. Patients aged 20-39 years with heart failure were more likely to be African American and obese than heart failure patients in older cohorts. 

2. All young patients were less likely to show signs of peripheral edema, rales, and less likely to report dyspnea. 

3. The most common etiology of heart failure among all young patients was idiopathic dilated cardiomyopathy. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Heart failure patients from 20-39 years old were more likely to be African American and obese, and their etiology was more likely to be non-ischemic. Younger patients also had fewer comorbidities, but despite this had similar mortality rates as patients aged 50-60 years. These younger patients reported the worst quality of life and were also less adherent to medication on average. Presentation of heart failure also differed among younger patients, who were significantly less likely to show fluid extravasation in the form of peripheral edema and rales. Lack of these hallmark signs of heart failure suggest a diagnostic challenge to clinicians assessing young patients with heart failure.

Click to read the study in the Journal of the American College of Cardiology

In-Depth: 7599 patients in the CHARM randomized clinical trial registry were analyzed post-hoc, stratified by age groups of 20-39, 40-49, 50-59, 60-69, and over 70 years. 18% of young patients were of Black ethnicity compared to 2% in the oldest age group (p<0.0001). 23% of young patients wer eobese compared with 6% in the oldest age group (p<0.0001). Dyspnea was reported win 45% of young patients versus in 68% of older patients (p<0.0001). Patient-reported quality of life was 52.6 in young patients and improved with age to 35.3 in older patients (p<0.0001). Adherence was 80% in younger patients and 88% in older patients (p<0.0001).

By Gina Siddiqui and Allen Ho

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