Abstract Body: Background:
Heart failure (HF) consists of two subtypes: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) with heterogeneous age of onset and risk factor profiles. Characterizing the distribution of age of onset and baseline risk factors for each HF subtype in contemporary samples may provide insight into early disease presentation and guide preventive strategies.

Methods:
We assembled a contemporary cohort of adults aged 30 years and older with a diagnosis of HF in 2024 using electronic health record (EHR) data from an integrated U.S health system that includes eleven hospitals. HF diagnoses were defined as ≥1 inpatient or ≥2 outpatient standardized ICD diagnosis codes. We excluded patients without an echocardiogram within three years of diagnosis. Two subgroups were defined by ejection fraction as the HFpEF strata (EF ≥50%) and the HFrEF strata (EF <50%). We examined age (30-49, 50-64, ≥65 years) and burden of risk factors (obesity, hypertension, diabetes, and chronic kidney disease) across subgroups.

Results:
Our EHR-based cohort included 6980 in the HFpEF cohort and 3347 in the HFrEF cohort. The distribution of age differed for HFpEF and HFrEF. Among HFpEF, 4.3% were aged 30-49 years, 16.9% 50-64 years, and 78.8% ≥65 years. For HFrEF, 10.6% were aged 30-49 years, 26.8% 50-64 years, and 62.6% ≥65 years. Risk factor burden was high in both HF subtypes (Table) with hypertension being nearly universal, especially above age 50.

Conclusions:
We characterized a contemporary real-world HFpEF and HFrEF cohort. Risk factor burden is substantial across all age groups, even with early-onset HF; this emphasizes the need for targeted prevention and management strategies beginning in young adulthood.