Heart failure with preserved ejection fraction was associated with lower 30-day mortality compared to other LVEF categories (HR 0.67; 95% CI 0.52-0.88; P=0.003), though overall mortality did not differ.
Cohort (n=5,824)
No
Is left ventricular ejection fraction category associated with mortality differences in heart failure patients, considering sex and comorbidities?
In a large Swiss cohort, overall mortality did not differ significantly across LVEF categories, but women had higher overall mortality and HFpEF was associated with lower 30-day mortality.
Estimación del efecto: HR 0.67 (95% CI 0.52-0.88)
valor p: p=0.003
AIMS: Understanding heart failure (HF) characteristics is essential to improve patient outcomes. Categorizing HF beyond left ventricular ejection fraction (LVEF) is challenging due to heterogeneous clinical presentation and aetiologies. Despite global studies on HF, the role of LVEF on mortality remains controversial. We explored the association of LVEF with mortality, considering sex differences and comorbidities in a cohort from the largest tertiary cardiovascular centre in Switzerland. METHODS: HF patients admitted to the University Hospital of Bern from January 2015 to December 2019 were evaluated. LVEF was used to classify patients into HF with preserved ejection fraction (HFpEF), HF with mid-range ejection fraction (HFmrEF) and HF with reduced preserved ejection fraction (HFrEF) categories. Cox proportional hazard models and time-stratified analyses adjusted for potential confounders were employed. RESULTS: A total of 5824 HF patients were included, and 2912 died over a median follow-up time of 3.39 years. Mortality rates across LVEF categories showed no significant differences, while overall, women showed significantly higher mortality; 30 day mortality was lower in the HFpEF category hazard ratio (HR) 0.67, 95% confidence interval (CI): 0.52-0.88, P = 0.003, with persistent effects upon stratification in males (HR 0.59, 95% CI: 0.42-0.81, P < 0.001) and non-diabetics (HR 0.62, 95% CI: 0.44-0.87, P = 0.005). An isolated reduction in HFpEF mortality was observed in females after 1 year (HR 0.72, 95% CI: 0.53-0.98, P = 0.035). CONCLUSIONS: The prognostic role of LVEF on all-cause mortality remains unclear, while differences in mortality rate distribution between women and men mirror established HF pathophysiological sex differences. Future HF studies should focus on HF aetiology and include measures beyond LVEF for comprehensive characterization.
Artiles et al. (Tue,) conducted a cohort in Heart failure (n=5,824). LVEF categories (HFpEF, HFmrEF, HFrEF) vs. Across LVEF categories was evaluated on 30-day mortality (HFpEF vs other categories) (HR 0.67, 95% CI 0.52-0.88, p=0.003). Heart failure with preserved ejection fraction was associated with lower 30-day mortality compared to other LVEF categories (HR 0.67; 95% CI 0.52-0.88; P=0.003), though overall mortality did not differ.
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