Improved Survival in Octogenarians With Heart Failure: 15-Year Cohort Study From a National Referral Center

Background: Octogenarians (aged ≥80 years) represent a significant subpopulation of heart failure (HF) patients yet remain underrepresented in clinical trials. Objectives: This study evaluates trends in mortality among octogenarians with HF between 2009 and 2024. Methods: This was a retrospective analysis of HF patients treated at a single tertiary center. The primary outcome was all-cause mortality. Kaplan-Meier survival analysis and Cox proportional hazards regression models were applied, stratifying patients by age (octogenarians or older and nonoctogenarians), by time period (before and after June 2016), HF type (heart failure with preserved [HFpEF] and reduced ejection fraction), and frailty status. Results: Among 32,892 patients (median age 72 years, IQR: 64-82; 58% [19,168] males), 11,013 (33%) were octogenarians or older. Over a 5-year median follow-up (IQR: 1-7), 18,558 (56%) died. Five-year mortality was 69% (7,599/11,013) in octogenarians or older vs 37% (8,095/21,879) in nonoctogenarians (P < 0.001). Use of guideline-directed medical therapy increased over time. Adjusted HRs for mortality in octogenarians or older, compared with nonoctogenarians, decreased between the early period (HR: 2.1; 95% CI: 2.03-2.19; P < 0.001) compared to the later period (HR: 1.6; 95% CI: 1.57-1.75; P < 0.001; P for interaction <0.001). In the overall cohort, mortality HR declined in HFpEF patients (HR: 2.02-1.62, P for interaction <0.001), but not in heart failure with reduced ejection fraction patients (HR: 2.25-2.00, P for interaction = 0.400). In the overall cohort, decreases in mortality HR between the early and late period were significant in nonfrail patients. Conclusions: Over a 15-year period, mortality risks among octogenarians and older with HF decreased, especially in HFpEF and nonfrail patients.