Epidemiology of heart failure in young adults: a French nationwide cohort study

Aims Heart failure (HF) in young adults is uncommon, and changes in its incidence and prognosis in recent years are poorly described. Methods and results The incidence and prognosis of HF in young adults (18-50 years) were characterized using nationwide medico-administrative data from the French National Hospitalization Database (period 2013-2018). A total of 1,486 877 patients hospitalized for incident HF were identified, including 70 075 (4.7%) patients aged 18-50 years (estimated incidence of 0.44 parts per thousand for this age group). During the study period, the overall incidence of HF tended to decrease in the overall population but significantly increased by similar to 0.041 parts per thousand in young adults (P < 0.001). This increase was notably observed among young men (from 0.51 parts per thousand to 0.59 parts per thousand, P < 0.001), particularly those aged 36-50 years. In these young men, ischaemic heart disease (IHD) was the most frequently reported cause of HF, whereas non-ischaemic HF was mainly observed in patients <= 35 years old. In contrast to non-ischaemic HF, the incidence of IHD increased over the study period, which suggests that IHD-related HF is progressively affecting younger patients. Concordantly, young HF patients presented with high rates of traditional IHD risk factors, including obesity, smoking, hypertension, dyslipidaemia, or diabetes. Lastly, the rates of re-hospitalization (for HF or for any cause) within two years after the first HF event and in-hospital mortality were high in all groups, indicating a poor-prognosis population. Conclusion Strategies for the prevention of HF risk factors should be strongly considered for patients under 50 years old.