Are left ventricular ejection fraction categories associated with distinct patient profiles and outcomes in a real-world heart failure cohort?
In a large French nationwide cohort, LVEF categories were associated with distinct outcomes, with HFmrEF and HFpEF showing lower mortality and HF hospitalization risks than HFrEF, alongside notable underuse of guideline-directed medical therapy.
BACKGROUND: The management of heart failure relies on categorizing patients by left ventricular ejection fraction: reduced (HFrEF), mildly reduced (HFmrEF) or preserved (HFpEF). AIMS: This study aimed to examine the characteristics, management and outcomes across left ventricular ejection fraction categories within a large real-world cohort. METHODS: Using the French national health database, adults hospitalized at least once for heart failure in 2019 with a left ventricular ejection fraction coding were identified. Characteristics, including demographics, comorbidities, medications and medical consultations, were described. Clinical outcomes, including all-cause mortality, all-cause hospitalization and heart failure-related hospitalization, were assessed across left ventricular ejection fraction categories using Cox multivariable analyses. RESULTS: Of 27,294 patients, 37% had HFrEF, 20% had HFmrEF and 43% had HFpEF. Patients with HFpEF were older and more comorbid than those with HFrEF; patients with HFmrEF showed intermediate features. Adjusted analyses found that the HFmrEF and HFpEF categories had lower risks of all-cause mortality (hazard ratio 0.71, 95% confidence interval 0.63-0.80 and hazard ratio 0.65, 95% confidence interval 0.60-0.72, respectively) and heart failure hospitalization (hazard ratio 0.65, 95% confidence interval 0.59-0.72 and hazard ratio 0.89, 95% confidence interval 0.82-0.96, respectively) compared with the HFrEF category. Although polypharmacy was frequent - ranging from 53% in the HFrEF category to 65% in the HFpEF category receiving at least 10 drugs - only 24% of patients with HFrEF received guideline-recommended heart failure triple therapy. The mean annual rate of cardiologist consultations remained low - nearly one per patient - regardless of left ventricular ejection fraction. CONCLUSIONS: In our nationwide study, left ventricular ejection fraction categories were associated with distinct patient profiles and outcomes, supporting the tripartite categorization. There was notable underuse of guideline-directed heart failure therapy, despite widespread polypharmacy, and infrequent specialist follow-up, underscoring the need for strategies to improve heart failure management in clinical practice.
Isnard et al. (Fri,) studied this question.