title: Heart failure in younger patients: the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC).
abstract: OBJECTIVE
  Our understanding of heart failure in younger patients is limited. The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) database, which consisted of 24 prospective observational studies and 7 randomized trials, was used to investigate the clinical characteristics, treatment, and outcomes of younger patients.
  
  
  RESULTS
  Patients were stratified into six age categories: <40 (n = 876), 40-49 (n = 2638), 50-59 (n = 6894), 60-69 (n = 12 071), 70-79 (n = 13 368), and ≥80 years (n = 6079). Of 41 926 patients, 2.1, 8.4, and 24.8% were younger than 40, 50, and 60 years of age, respectively. Comparing young (<40 years) against elderly (≥80 years), younger patients were more likely to be male (71 vs. 48%) and have idiopathic cardiomyopathy (63 vs. 7%). Younger patients reported better New York Heart Association functional class despite more severe left ventricular dysfunction (median ejection fraction: 31 vs. 42%, all P < 0.0001). Comorbidities such as hypertension, myocardial infarction, and atrial fibrillation were much less common in the young. Younger patients received more disease-modifying pharmacological therapy than their older counterparts. Across the younger age groups (<40, 40-49, and 50-59 years), mortality rates were low: 1 year 6.7, 6.6, and 7.5%, respectively; 2 year 11.7, 11.5, 13.0%; and 3 years 16.5, 16.2, 18.2%. Furthermore, 1-, 2-, and 3-year mortality rates increased sharply beyond 60 years and were greatest in the elderly (≥80 years): 28.2, 44.5, and 57.2%, respectively.
  
  
  CONCLUSIONS
  Younger patients with heart failure have different clinical characteristics including different aetiologies, more severe left ventricular dysfunction, and less severe symptoms. Three-year mortality rates are lower for all age groups under 60 years compared with older patients.
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, Glasgow, UK chihmun@gmail.com.
authors.forename: Chih M
authors.initials: CM
authors.lastname: Wong
authors.affiliation: Division of Cardiology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Nathaniel M
authors.initials: NM
authors.lastname: Hawkins
authors.affiliation: Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, Glasgow, UK.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Petrie
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
authors.forename: Pardeep S
authors.initials: PS
authors.lastname: Jhund
authors.affiliation: Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, Glasgow, UK.
authors.forename: Roy S
authors.initials: RS
authors.lastname: Gardner
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Cono A
authors.initials: CA
authors.lastname: Ariti
authors.affiliation: Department of Medicine, The University of Auckland, Auckland, New Zealand.
authors.forename: Katrina K
authors.initials: KK
authors.lastname: Poppe
authors.affiliation: Department of Medicine, The University of Auckland, Auckland, New Zealand.
authors.forename: Nikki
authors.initials: N
authors.lastname: Earle
authors.affiliation: Unitec, Auckland, New Zealand.
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Whalley
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK.
authors.forename: Iain B
authors.initials: IB
authors.lastname: Squire
authors.affiliation: Department of Medicine, The University of Auckland, Auckland, New Zealand National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Doughty
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D014943:Global Health; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D002316:Cardiotonic Agents
keywords: Ejection fraction; Heart failure; Young