Too Old for a New Heart?
by Adrienne Mueller, PhD
May 8, 2025
Across a spectrum of diseases from cancer to heart failure, older patients face systemic bias in their treatment. Individuals in the 70s, 80s, and 90s are less likely to be offered the same options for care as younger patients. In the case of heart failure, patients of advanced age are often considered to be poor candidates for heart transplants. The rationale for this assessment is that younger recipients are considered more likely to have better post-transplant outcomes. Fewer than 5% of heart transplant patients have been age 70 or above – in contrast to approximately 30% of heart transplant patients who are aged between 60 and 69. Since US citizens are continuing to live longer, it is therefore important to update our thoughts on what age is considered ‘too old’ to receive a heart transplant. Additionally, since whether a patient receives a heart or not can literally be a matter of life or death, it is important to assess wither patients of advanced years do in fact have poorer outcomes than younger patients after receiving a heart transplant in the current era of care.
To address these questions, Dr. Erik Henricksen and Dr. Kiran Khush recently led a study investigating the trends in heart transplant outcomes in patients of different age groups in the US over the past 25 years. Their findings were published in the Journal of Heart and Lung Transplantation.
The investigators found that although heart transplant recipients aged 70 or above had a slightly lower 1-year survival rate than individuals younger than 60 and individuals aged between 60 and 69 – the difference was not statistically significant. Patients between 60 and 69 years of age and patients aged 70 or older also had very similar – and not statistically different – 5-year survival rates.
The study also showed that outcomes for patients aged 70 and above had changed over the last two decades: the one-year survival for individuals aged 70 or above has significantly improved from 80.7% in patients treated between 2000-2009 to 88.5% in patients treated since 2018.
Ultimately this study shows that heart transplant outcomes are excellent for carefully selected patients aged 70 or above. Clinicians should therefore strive to be more inclusive of individuals in this age bracket when considering potential candidates for heart transplants.
Additional Stanford Cardiovascular Institute-affiliated investigators who contributed to this work include Jeffrey J. Teuteberg, Helen Luikart, Joyce Njoroge, and Brandon A. Guenthart.
Dr. Erik Henricksen
Dr. Kiran Khush