OBJECTIVES This study sought to determine whether age modifies the impact of key comorbidities on clinical outcomes for patients with heart failure with reduced ejection fraction (HFrEF). BACKGROUND Comorbidities impact outcomes in HFrEF. However, the effect of age on the impact of comorbidities on prognosis is not clearly understood. METHODS Cox proportional hazards models were used assessed interactions between age and comorbidities on the primary composite endpoint (all-cause mortality or hospitalization) and secondary endpoints in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) multicenter trial of 2,331 patients with HFrEF. RESULTS Age did not significantly modify the effect of any comorbidity on the primary endpoint. However, age significantly modified the effect of body mass index (BMI) on all-cause mortality (interaction p = 0.02). Among patients ≥70 years of age, there was a U-shaped relationship between BMI and 1-year mortality, where BMI of 20 kg/m2 corresponded to 17.6%; a BMI of 30 kg/m2 corresponded to 7.0%; and a BMI of 40 kg/m2 corresponded to 11%. For patients <60 years of age, mortality increased nonsignificantly from 3.2% to 3.7% with increasing BMI. Age also modified the effect of depressive symptoms on all-cause mortality (interaction p = 0.03). Among patients ≥70 years of age, a 1-year mortality rate significantly increased from 7.8% for a Beck Depression Inventory (BDI) score of 5% to 15.6% for BDI of 20. For patients <60 years of age, mortality was nonsignificantly related to BDI. Cumulative comorbidity scores were stronger predictors than age for mortality/hospitalization. CONCLUSIONS In chronic HFrEF, age markedly altered the impact of BMI and depressive symptoms on all-cause mortality, with much higher risk in older patients, but was not as strong a predictor of mortality/hospitalizations as cumulative comorbidity score. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437).

中文翻译：

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年龄对射血分数降低的心力衰竭合并症和结局的影响。

目的本研究旨在确定年龄是否能改善射血分数（HFrEF）降低的心力衰竭患者的关键合并症对临床结局的影响。背景合并症影响HFrEF的预后。但是，年龄对合并症对预后影响的影响尚不清楚。方法采用Cox比例风险模型评估了HF-ACTION（心力衰竭：运动训练的对照试验结果）多中心试验的主要复合终点（全因死亡率或住院）和次要终点之间的年龄与合并症之间的相互作用。 2,331例HFrEF。结果年龄并未显着改变任何合并症对主要终点的影响。然而，年龄显着改变了体重指数（BMI）对全因死亡率的影响（相互作用p = 0.02）。≥70岁的患者中，BMI与1年死亡率之间呈U型关系，其中BMI为20 kg / m2占17.6％； BMI为20 kg / m2。BMI为30 kg / m2相当于7.0％; BMI为40 kg / m2相当于11％。对于＜60岁的患者，随着BMI的增加，死亡率从3.2％显着增加到3.7％。年龄还改变了抑郁症状对全因死亡率的影响（相互作用p = 0.03）。在≥70岁的患者中，一年的死亡率从贝克抑郁量表（BDI）分数5％的7.8％显着提高到BDI为20的15.6％。对于60岁以下的患者，死亡率无明显意义。与BDI有关。对于死亡率/住院治疗，合并合并症评分是比年龄更强的预测因子。结论在慢性HFrEF中，年龄显着改变了BMI和抑郁症状对全因死亡率的影响，老年患者的危险性高得多，但与累积合并症评分相比，死亡率/住院治疗的预测力不强。（心力衰竭：运动训练的对照试验研究结果[HF-ACTION]； NCT00047437）。