Clinical, echocardiographic profile, and outcome of heart failure patients with preserved ejection fraction

Context: Approximately half of the patients with heart failure have preserved ejection fraction (HFpEF). Epidemiologic studies and randomized trials provide somewhat conflicting data regarding outcomes of HFpEF. Aims: The objective is to study the clinical and echocardiographic profile of patients admitted with HFpEF and estimate outcomes. Settings and Design: This is a prospective observational study on patients with new-onset HF requiring hospitalization and normal EF and evidence of diastolic dysfunction in echocardiography. Subjects and Methods: Risk factors for HFpEF, clinical features, and echocardiographic parameters were recorded. The primary outcome studied was mortality at 1 year and the secondary outcome was rehospitalization at 1 year. Statistical Analysis Used: Variables were analyzed using Student's t -test and Chi-square test. Univariate and multivariate analysis were done to find out predictors of outcomes. Results: A total of 104 patients admitted with the first episode of HF were found to have left ventricular ejection fraction ≥ 50% and diastolic dysfunction. Associated cardiac conditions were hypertension in 77.8%, diabetes in 38.5%, ischemic heart disease in 30.7%, and atrial fibrillation in 32.7%. In our study, 42 patients (40.1%) had rehospitalization within 1 year. The mortality rate at 1 year was 15.4% (16 patients). The parameters found to be significantly correlated with mortality in the univariate analysis included age, high BP, anemia, hyponatremia, low isovolumetric relaxation time, and higher E/e' ratio. Multivariate analysis showed advanced age, hyponatremia, and high E/e' to be independent predictors of mortality. Conclusions: Among hospitalized patients with new-onset HFpEF annual mortality rate is as high as 15.4%. Advanced age, hyponatremia, and high E/e' were found to be independent predictors of mortality.