title: Acute heart failure in the young: Clinical characteristics and biomarker profiles.
abstract: BACKGROUND
  Young patients (<50years) exhibit specific characteristics in chronic heart failure (HF), but their phenotype in acute heart failure (AHF) is not well described.
  
  
  RESULTS
  2033 patients of the PROTECT trial were divided into two groups: young patients (≤50years) and older patients (>50years). Biomarkers from different pathophysiological domains were available in 1266 patients. Patients were compared with regard to clinical characteristics, biomarker profiles, and in-hospital (worsening renal function [WRF] and decongestion) and post-discharge (180-day survival) outcome. Young patients (n=121) were mostly men, had fewer comorbidities with better renal function, and more often had a reduced ejection fraction. At admission, young patients were more likely to have jugular venous distension, but less rales and dyspnea compared with older patients. During hospitalization, young patients received higher loop diuretic doses and were decongested earlier than older patients. WRF occurred less frequently in young patients (5.9% vs. 13.3%, p=0.020) and they were more often discharged alive. At 180days, the mortality of young patients was lower than that of the older patients (9.9% vs. 18.1, p=0.021). Biomarker levels indicative of inflammation and renal damage were lower in the young, although they exhibited higher BNP levels than older patients.
  
  
  CONCLUSIONS
  Despite use of higher diuretic doses, young patients with AHF less often developed WRF during hospitalization and had better outcomes than older patients. Differences in biomarker levels between the age groups suggest distinct underlying pathophysiologies. https://clinicaltrials.gov numbers NCT00328692 and NCT00354458.
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jasper
authors.initials: J
authors.lastname: Tromp
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Cardiology, Heart Center Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Meyer
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Inova Heart and Vascular Institute, Falls Church, VA, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: University of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Howard C
authors.initials: HC
authors.lastname: Dittrich
authors.affiliation: Medical University, Clinical Military Hospital, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.affiliation: University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.affiliation: Momentum Research, Durham, NC, USA.
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
authors.affiliation: Momentum Research, Durham, NC, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Davison
authors.affiliation: University of Hull, Kingston upon Hull, United Kingdom.
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.affiliation: Merck Research Laboratories, Rahway, NJ, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Bloomfield
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: p.van.der.meer@umcg.nl.
authors.forename: Peter
authors.initials: P
authors.lastname: van der Meer
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000032:analysis*; D015897:Comorbidity; D004232:Diuretics / Q000008:administration & dosage; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D063189:Symptom Assessment / Q000379:methods*; D014970:Xanthines / Q000008:administration & dosage*
chemical_list: D015415:Biomarkers; D004232:Diuretics; D014970:Xanthines; C073525:rolofylline
keywords: Age; Biomarker; Heart failure; Young