Advanced Heart Failure Stage Associated With Increased Risk of All-Cause Mortality

A study was conducted to examine the relationship between stages of early heart failure and risk for future cardiovascular and non-CV events.

The risk for heart failure hospitalization (HFH), ischemic heart disease (IHD), stroke, and all-cause death increases with increasing severity of HF stage among elderly high-risk patients, according to a study in BMC Geriatrics.

Elderly patients with HF stages A to C from the Copenhagen Heart Failure Risk Study were consecutively recruited from December 2014 to June 2016. Researchers assessed patients’ 3-year risk for the main composite outcome of HFH, IHD, stroke, and all-cause death.

A total of 400 patients were included, with 44% of patients in stage A, 38% of patients in stage B, and 18% patients in stage C of HF. The participants (51.5% men) had an overall median age of 72 years, with patients in stages B (median age, 75 years) and C (median age 74 years) older than those in stage A (median age, 69 years).

After a median follow-up of 3.3 years, 83 events occurred. Within the first year, 4.5% (95% CI, 1.5-7.6), 10.0% (95% CI, 5.2-14.8), and 16.4% (95% CI, 7.9-24.9) of patients had an event in HF stages A, B, and C, respectively.

The 3-year risk for the main composite outcome was 12.8% (95% CI, 7.8-17.9) in patients with HF stage A, 22.8% (95% CI, 16.1-29.6) in patients with HF stage B, and 31.8% (95% CI, 21.0-42.6) in patients with HF stage C.

The risk for noncardiovascular (non-CV) hospitalization also increased with HF stage severity. The absolute 3-year risk was 37.3% (95% CI, 30.2-44.4), 49.7% (95% CI, 41.6-57.8), and 54.8% (95% CI, 43.4-66.2) for patients with HF stages A, B, and C, respectively.

The risk for HFH was the lowest among the categories, although patients with HF stage C had an increased risk vs patients with HF stages A and B.

Among several study limitations, the population was elderly patients recently admitted at a hospital, and so the results do not reflect the general population. Also, the sample size limited the power of reported outcomes, and it was not possible to investigate important subgroups and to adjust for additional confounders in the Cox proportional hazards model. Further, an effect of unmeasured confounders cannot be totally excluded.

“The 3-year risk of experiencing a HFH was surprisingly low compared to the risk of non-CV hospitalizations,” the researchers stated. “The adverse impact of non-CV comorbidities on future outcomes in elderly individuals with HF stages A-C appears especially profound. Our findings therefore further emphasize the importance of addressing underlying comorbidities in elderly patients with high risk for HF and early stages of HF.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Parveen S, Zareini B, Arulmurugananthavadivel A, et al. Association between early detected heart failure stages and future cardiovascular and non-cardiovascular events in the elderly (Copenhagen Heart Failure Risk Study). BMC Geriatr. Published online March 21, 2022. doi: 10.1186/s12877-022-02875-1