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October 5, 2017HeartOpen Access

Outcomes of de novo and acute decompensated heart failure patients according to ejection fraction

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Key result

HFpEF was associated with lower mortality compared with HFrEF in acute decompensated heart failure (40.0% vs 44.7%; P=0.007), but not in de novo acute heart failure (27.7% vs 26.9%; P=0.14).

Population

5,414 patients with acute heart failure with available ejection fraction data, including 2,867 with de novo…

Design

Cohort

Authors

KCKi Hong ChoiGLGa-Yeon LeeJCJin‐Oh Choi

Discussion

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Overview

Outcomes in acute HF by EF category remain unclear; leaves open whether HFmrEF prognosis differs enough to guide distinct care.

Key Points

  • To evaluate differences in all-cause mortality across ejection fraction categories in patients presenting with de novo acute heart failure compared to acute decompensated heart failure.
  • Recruited 5,625 consecutive patients presenting with acute heart failure across 10 university hospitals between March 2011 and February 2014.
  • Analyzed 5,414 patients with recorded ejection fraction data, stratifying them into de novo (N=2,867) and acute decompensated heart failure (N=2,547) cohorts with preserved (EF≥50%), mid-range (40%≤EF<50%), or reduced (EF<40%) ejection fraction.
  • In de novo acute heart failure, all-cause death rates did not differ significantly between preserved and reduced ejection fraction cohorts (206/744 [27.7%] vs 438/1631 [26.9%]; adjusted HR 1.15, 95% CI 0.96 to 1.38, p=0.14).
  • In acute decompensated heart failure, reduced ejection fraction was associated with significantly higher mortality than preserved ejection fraction (694/1551 [44.7%] vs 245/613 [40.0%]; adjusted HR 1.25, 95% CI 1.06 to 1.47, p=0.007).
  • For acute decompensated patients, mid-range ejection fraction conferred lower ≤1-year mortality than reduced ejection fraction (88/383 [23.0%] vs 430/1551 [27.7%]; adjusted HR 1.31, 95% CI 1.03 to 1.65, p=0.03), but higher >1-year mortality than preserved ejection fraction (83/295 [28.1%] vs 101/469 [21.5%]; adjusted HR 0.70, 95% CI 0.52 to 0.96, p=0.02).

Study Design

Type

Cohort (n=5,414)

Multicenter

Yes

Structured PICO

P
Population
5,414 patients with de novo acute heart failure or acute decompensated heart failure, stratified by ejection fraction.
O
Outcome
All-cause deathhard clinical

Main Result

Hazard Ratio: 1.15 (95% CI 0.96–1.38)

Absolute Event Rate: 27.7% vs 26.9%

p-value: p=0.14

The prognostic impact of ejection fraction in acute heart failure differs based on whether the presentation is de novo or an acute decompensation of chronic heart failure.

Cite This Study

Choi et al. (2017) conducted a cohort in De novo acute heart failure or acute decompensated heart failure (n=5,414). Heart failure with preserved ejection fraction (HFpEF) vs. Heart failure with reduced ejection fraction (HFrEF) was evaluated on All-cause death (in de novo acute heart failure) (adjusted HR 1.15, 95% CI 0.96 to 1.38, p=0.14). HFpEF was associated with lower mortality compared with HFrEF in acute decompensated heart failure (40.0% vs 44.7%; P=0.007), but not in de novo acute heart failure (27.7% vs 26.9%; P=0.14).

synapsesocial.com/papers/6a6ba55945e10bb5bcf2fa83https://doi.org/10.1136/heartjnl-2017-311813
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis2011 · 761 citations
  2. 2Multicenter Prospective Observational Study on Acute and Chronic Heart Failure2013 · 201 citations
  3. 3Predictors of Cardiac Function in Acute Heart Failure Patients with Mid-Range Ejection Fraction: AURORA Study2019 · 5 citations
  4. 4Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study2007 · 444 citations
  5. 5Outcome of Heart Failure with Preserved Ejection Fraction in a Population-Based Study2006 · 1,976 citations