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December 11, 2020Cor et VasaOpen Access

Do patients with heart failure and preserved, mid-range or reduced ejection fraction have different outcomes?

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Key result

Patients with reduced ejection fraction (HFrEF) had a significantly higher risk of all-cause mortality compared to those with preserved ejection fraction (HFpEF) (HR 3.67).

Why the study?

Determining the prognosis of patients with HFpEF and HFmrEF remains challenging, prompting an evaluation of the etiology, clinical characteristics, and prognosis of HFpEF, HFmrEF, and HFrEF in Bulgaria.

Do patients with heart failure and preserved, mid-range or reduced ejection fraction have different outcomes?

Study Design

Type

Observational (n=890)

Multicenter

No

Structured PICO

Do patients with heart failure and preserved, mid-range or reduced ejection fraction have different outcomes?

P

Population

890 patients admitted for decompensated chronic heart failure, stratified by ejection fraction into HFpEF, HFmrEF, and HFrEF, followed for a median of 5.8 years.

E

Exposure

Heart failure with mid-range ejection fraction (HFmrEF) or reduced ejection fraction (HFrEF)

C

Comparator

Heart failure with preserved ejection fraction (HFpEF)

O

Outcome

All-cause mortality and rehospitalizationshard clinical

Main Result

Hazard Ratio: 3.67 (95% CI 1.74–5.56)

Absolute Event Rate: 61.8% vs 34.6%

p-value: p=<0.01

Limitations

Single-center study, which may limit generalizability to other populations or geographical areas.
Lack of serial echocardiographic data to track changes in ejection fraction over time.
Postdischarge data were not directly tracked or recorded.
Cardiovascular-specific mortality was not investigated.
Cause-specific readmissions were based on diagnostic-related group codes and could be subject to misclassification.
Single center in Sofia; results may not be extended to other populations with different ethnicity and/or from other geographical areas
No serial data about EF, cannot determine if patients had improved or reduced EF over time
Postdischarge data were not directly tracked or recorded
Did not investigate cardiovascular-specific mortality
Cause-specific readmissions were based on diagnostic-related group codes and could be a subject to misclassification

Implication

Patients with HFmrEF have mortality and rehospitalization rates similar to HFrEF and worse than HFpEF, suggesting HFmrEF may represent an early stage of HFrEF.

Abstract

Kontext: Terminologie pouĹžĂvanĂĄ v souvislosti se srdeÄnĂm selhĂĄnĂm (heart failure, HF) je podle doporuÄenĂ˝ch postupĹŻ EvropskĂŠ kardiologickĂŠ spoleÄnosti z roku 2016 (2016 European Society of Cardiology Guidelines) zaloĹžena na namÄĹenĂ˝ch hodnotĂĄch ejekÄnĂ frakce levĂŠ komory srdeÄnĂ (EF LK) s nĂĄsledujĂcĂ klasifikacĂ: ≥ 50 %, HF se zachovanou ejekÄnĂ frakcĂ (HF with preserved EF, HFpEF), < 40 %, HF se snĂĹženou ejekÄnĂ frakcĂ (HF with reduced EF, HFrEF) a 40-49 %, HF s ejekÄnĂ frakcĂ ve stĹednĂm pĂĄsmu (HF with mid-range EF, HFmrEF). PrognĂłza pacientĹŻ s HFpEF a HFmrEF se zatĂm stanovuje pomÄrnÄ obtĂĹžnÄ. CĂl: CĂlem tohoto ÄlĂĄnku je popsat etiologii, rizikovĂŠ faktory, klinickĂŠ a echokardiografickĂŠ charakteristiky a prognĂłzu pacientĹŻ s HFpEF, HFmrEF a HFrEF v Bulharsku. Metody: V naĹĄĂ observaÄnĂ studii byly vĹĄechny Ăşdaje pacientĹŻ zĂskĂĄny z naĹĄĂ nemocniÄnĂ databĂĄze. Ve studii se hodnotily Ăşdaje 890 pacientĹŻ pĹijatĂ˝ch na kliniku kardiologie v obdobĂ 2012 aĹž 2014 pro dekompenzovanĂŠ chronickĂŠ srdeÄnĂ selhĂĄnĂ. VĂ˝sledky: Parametry sledovanĂ˝mi u hodnocenĂ˝ch skupin pacientĹŻ s HFpEF (609; 68,4 %), HFmrEF (145; 16,3 %) a HFrEF (136; 15,3 %) byly mortalita z jakĂ˝chkoli pĹĂÄin a rehospitalizace. BÄhem sledovĂĄnĂ v dĂŠlce 5,8 ± 1,5 roku dosĂĄhla mortalita hodnot 34,6 % v pĹĂpadÄ HFpEF, 55,9 % u HFmrEF a 61,8 % u pacientĹŻ s HFrEF. Po adjustaci byla mortalita vĂ˝znamnÄ vyĹĄĹĄĂ u HFrEF a HFmrEF oproti HFpEF (HR 3,67; 95% CI 1,74-5,56; p < 0,01 v pĹĂpadÄ HFrEF a HR 2,96; 95% CI 1,48-4,76; p < 0,01 u HFmrEF). Podle naĹĄich ĂşdajĹŻ doĹĄlo po druhĂŠm roce sledovĂĄnĂ u pacientĹŻ s HFrEF ke statisticky nevĂ˝znamnĂŠmu zkrĂĄcenĂ pĹeĹžitĂ ve srovnĂĄnĂ s pacienty s HFmrEF (HR 1,72; 95% CI 1,49-2,48; p = 0,12). V obdobĂ s mediĂĄnem 1,2 roku bylo znovu hospitalizovĂĄno 22,3 % pacientĹŻ s HFpEF, 33,1 % s HFmrEF a 33,7 % pacientĹŻ s HFrEF. U pacientĹŻ s HFrEF i HFmrEF bylo zjiĹĄtÄno vĂ˝znamnÄ vyĹĄĹĄĂ riziko opakovanĂŠho pĹĂjmu pro dekompenzovanĂŠ HF neĹž u pacientĹŻ s HFpEF (HR 1,67; 95% CI 1,20-2,35; p < 0,01 u HFrEF, a HR 1,58; 95% CI 1,12-2,22; p < 0,01 u HFmrEF). Riziko rehospitalizace bylo u pacientĹŻ s HFrEF a HFmrEF podobnĂŠ (HR 1,03; 95% CI 0,93-1,08; p = 0,65). AnalĂ˝za ROC urÄila jako meznĂ hodnotu EF 50 %, protoĹže EF LK < 50 % byla spojena s vyĹĄĹĄĂ mortalitou i vyĹĄĹĄĂmi poÄty opakovanĂ˝ch hospitalizacĂ u vĹĄech hodnocenĂ˝ch skupin jedincĹŻ s HF (AUC 0,67; senzitivita 65 %; specificita 72 %; p < 0,01). ZĂĄvÄr: NaĹĄe Ăşdaje prokĂĄzaly pĹĂznivÄjĹĄĂ prognĂłzu pacientĹŻ s HFpEF neĹž u pacientĹŻ s HFmrEF a HFrEF. Hodnoty ĂşmrtĂ a opakovanĂ˝ch hospitalizacĂ byly nicmĂŠnÄ u pacientĹŻ s HF < 50 % podobnĂŠ; to znamenĂĄ, Ĺže HFmrEF mĹŻĹže pĹedstavovat ÄasnĂŠ stadium HFrEF a pro pacienty s HFmrEF mohou bĂ˝t pĹĂnosnĂŠ stejnĂŠ strategie lĂŠÄby jako u pacientĹŻ s HFrEF. © 2020, ÄKS.

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Cite This Study

Pancheva et al. (2020) conducted an observational in Decompensated chronic heart failure (n=890). Reduced ejection fraction (HFrEF) vs. Preserved ejection fraction (HFpEF) was evaluated on All-cause mortality (HR 3.67, 95% CI 1.74-5.56, p=<0.01). Patients with reduced ejection fraction (HFrEF) had a significantly higher risk of all-cause mortality compared to those with preserved ejection fraction (HFpEF) (HR 3.67).

synapsesocial.com/papers/6a6ba55945e10bb5bcf2fa7d https://doi.org/10.33678/cor.2020.089

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