A population-based cohort analysis published in the American Heart Journal Plus: Cardiology Research and Practice examined the relationship between phenotypic age acceleration (PAA) and mortality outcomes among adults at risk for heart failure (HF). Data were derived from the National Health and Nutrition Examination Survey (NHANES) cycles spanning 1999–2010 and 2015–2018, including 19,665 participants aged ≥20 years. 

PAA was defined as the residual obtained by regressing phenotypic age on chronological age. Inclusion criteria comprised adults at risk for HF within the NHANES dataset, while specific exclusion criteria were not detailed in the abstract. Associations with all-cause mortality and cardiovascular mortality were evaluated using Kaplan–Meier analysis, weighted Cox proportional hazards models, Fine–Gray competing-risk models, and restricted cubic spline analysis.

Participants in the highest quartile of PAA demonstrated significantly elevated risks compared with those in the lowest quartile. The hazard ratio (HR) for all-cause mortality was 2.63 (95% confidence interval [CI], 2.31–2.98), while cardiovascular mortality showed an HR of 2.55 (95% CI, 2.00–3.25). 

Restricted cubic spline analysis indicated a nonlinear association between PAA and all-cause mortality (P for nonlinearity=0.005), with a threshold identified at PAA = −8.26. In contrast, the association between PAA and cardiovascular mortality was linear (P for nonlinearity=0.881). Competing-risk analysis confirmed that higher PAA remained significantly associated with cardiovascular mortality (subdistribution HR [SHR], 1.39; 95% CI, 1.15–1.68).

Higher PAA was associated with increased risks of both all-cause and cardiovascular mortality. These findings support its role as a potential marker for mortality risk in HF-prone populations.