Key result
Patients with HFrEF experienced higher all-cause readmissions and all-cause mortality compared to those with HFpEF over a median 18-month follow-up (P=0.01).
Why the study?
The study sought to estimate the prevalence of comorbidities in heart failure patients and evaluate their impact on functional status and clinical outcomes in an Indian population.
Cohort (n=113)
No
p-value: p=0.01
In an Indian cohort, patients with HFrEF experienced higher mortality and readmission rates than those with HFpEF, despite HFpEF patients having a higher burden of noncardiac comorbidities.
Comorbidity assessment may inform risk stratification in Indian HF patients; leaves open targeted intervention trials.
Background: We sought to estimate the prevalence of comorbidities in heart failure (HF) patients and their impact on functional status and clinical outcomes in Indian population. Patients and Methods: This prospective study was carried out at a tertiary care institute in North India. Patients were followed up prospectively for readmission and mortality for a median of 18 months. Results: A total of 113 HF patients were included in the study – 59 being HF with preserved ejection fraction (HFpEF) and 54 being HF with reduced ejection fraction (HFrEF). Patients with HFpEF were older (P = 0.03) with an equal proportion of males and females. Patients with HFpEF were less intensively treated with HF medications, particularly, spironolactone and other diuretics (P = 0.001). A total of 17 comorbidities were identified, and patients with HFpEF exhibited a higher burden of total and noncardiac comorbidities. After 18 months of follow-up, the all-cause readmissions and all-cause mortality were higher (P = 0.01) in patients with HFrEF as compared to HFpEF. The high New York Heart Association (NYHA) class, low ejection fraction, and high proBNP were associated with an increased risk of all-cause mortality. The mean Geriatric Nutritional Risk Index (GNRI) was significantly low in the HFrEF group (96.4 ± 10.8 vs. 102.3 ± 12.9, P = 0.009). Quality of life was poor in patients with HFrEF as compared with the HFpEF group, and 36-item Short-Form Health Survey score decreased proportionately with a decrease in EF. Multivariate analysis showed EF, GNRI, albumin (mg/dl), urea (mg/dl), sodium, and all-cause mortality to be associated with HF-related readmissions. Furthermore, NYHA class, urea (mg/dl), all-cause readmission, and HF-related readmission were seen to be associated with HF-related mortality. Conclusion: Despite differential prevalence, comorbidities exert substantial impact on the functional status in HFrEF as well as HFpEF patients. An individualized treatment approach based on comorbidities could provide a way forward, especially in low-resource countries.
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Mehrotra et al. (2019) conducted a cohort in Heart failure (n=113). Heart failure with reduced ejection fraction (HFrEF) vs. Heart failure with preserved ejection fraction (HFpEF) was evaluated on All-cause readmissions and all-cause mortality (p=0.01). Patients with HFrEF experienced higher all-cause readmissions and all-cause mortality compared to those with HFpEF over a median 18-month follow-up (P=0.01).
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