Causes of death and effect of co-morbidities on mortality in young patients with heart failure. Data from the Swedish Heart Failure, Cause of Death and National Patient Registers

Abstract Background The last two decades incidence and prevalence of heart failure (HF) among young patients have increased in Sweden. Up to the beginning of the 21st century mortality in patients with HF has decreased but causes of death and the effects of co-morbidity on mortality in young patients with HF are not well studied. Purpose To address causes of death and the effect of co-morbidity at baseline on mortality during the last decade in young patients with HF. Methods The Swedish Heart Failure Register (SwedeHF,) a nationwide quality register, was introduced in Sweden in 2003. All hospital discharge diagnoses are recorded in the National Patient Register (NPR) and deaths are registered in the Cause of Death Register. All patients ≥18 and <55 years with a HF diagnosis in SwedeHF were included and linked to the Cause of Death Register and NPR with the personal identification number. ICD 10-codes for all comorbidities and principal cause of death were identified during the observation period from 2003 to 2016. Besides, comorbidity and mortality data were compared with age and sex matched controls from the general population, database from Statistics Sweden (SCB). Results We identified 3752 (6.2%) patients <55 years from the total SwedeHF population (n=60,962) and added 7573 age and sex matched controls. There were 971 (25.9%) women and 2781 (74.1%) men mean age 44.9 (8.4) and 46.4 (7.3) years respectively. Among the young 604 (16.1%) patients died vs. 162 (2.2%) among matched controls (p<0.001) during the observation period. Principal cause of death was HF in 2.7% of the young patients (in men 3% vs. 1.4% in women (p=0.221)), other cardiovascular diseases 48.7% (27.7% in men vs. 20% in women (p=0.05)), congenital heart disease 4% (3% in men vs. 6.9% in women (p=0.077)), cancer 12.9% (9.6% in men vs. 23.6% in women (p=0.003)), neurologic disease 4.5% (5.4% in men vs. 1.4% in women (p=0.028)) suicide 0.8% (0.7% in men vs 1.4% in women (p=0.47)) and other causes 15.1% (15.9% in men vs 12.5% in women (p=0.179)) vs. 0, 26.5%, 1.2%, 32.7%, 1.2%, 9.9% and 18.5% in matched controls (all p<0.0001). The effect of co-morbidity at baseline on mortality in young patients with HF is presented in Figure 1. Effect of co-morbidity on mortality Conclusion Compared to matched controls young patients with HF had worse survival. Almost one quarter of women with HF had cancer as a principal cause of death. Men with AF, obesity and depression at baseline had higher risk to die than women. Women with HF and hypertension, PAH or kidney disease at baseline had higher risk to die than men with HF and the same co-morbidities. Acknowledgement/Funding Swedish state under the agreement concerning research and education of doctors, The Swedish Heart and Lung Foundation, Västra Götaland Region grants