August 12, 2026Journal of the American College of Cardiology936 citations
Clinical Presentation, Management, and In-Hospital Outcomes of Patients Admitted With Acute Decompensated Heart Failure With Preserved Systolic Function
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Key Result
Acute decompensated heart failure with preserved systolic function was associated with lower in-hospital mortality compared to systolic dysfunction (2.8% vs. 3.9%; adjusted OR 0.86; p=0.005).
Key Points
- This analysis aims to describe clinical characteristics, management, and outcomes of patients with acute decompensated heart failure and preserved systolic function.
- Data was analyzed from over 100,000 hospitalizations from the Acute Decompensated Heart Failure National Registry (ADHERE).
- In-hospital assessments focused on left ventricular function and associated characteristics.
- Heart failure with preserved systolic function was observed in 50.4% of patients with in-hospital assessment.
- In-hospital mortality for preserved systolic function patients was lower (2.8%) compared to systolic dysfunction patients (3.9%; OR: 0.86; p=0.005).
- Predictors of increased in-hospital mortality included blood urea nitrogen >37 mg/dl (OR: 2.53) and systolic blood pressure ≤125 mm Hg (OR: 2.58).
Study Design
Type
Observational (n=100,000)
Multicenter
Yes
Structured PICO
What are the clinical characteristics and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function compared to those with systolic dysfunction?
P
Population
>100,000 hospitalizations for acute decompensated heart failure from a national registry, comparing outcomes between patients with preserved versus reduced systolic function.
C
Comparator
Patients with systolic dysfunction
O
Outcome
In-hospital mortalityhard clinical
Patients hospitalized with acute decompensated heart failure with preserved systolic function represent half of HF admissions and have slightly lower in-hospital mortality but similar lengths of stay compared to those with systolic dysfunction.
Main Result
Odds Ratio: 0.86
Absolute Event Rate: 2.8% vs 3.9%
p-value: p=0.005
Abstract
UNLABELLED Approximately 50% of patients hospitalized for heart failure have preserved systolic function. These patients are more likely to be older, women, and hypertensive. Their duration of hospitalization is similar to that of heart failure patients with systolic dysfunction, but their in-hospital mortality risk is lower. This mortality risk is increased in the setting of renal insufficiency, and the two most important risk predictors are elevated blood urea nitrogen and systolic blood pressure 100,000 hospitalizations from the Acute Decompensated Heart Failure National Registry (ADHERE) database were analyzed. RESULTS Heart failure with PSF was present in 50.4% of patients with in-hospital assessment of left ventricular function. When compared with patients with systolic dysfunction, patients with PSF were more likely to be older, women, and hypertensive and less likely to have had a prior myocardial infarction or be receiving an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker. In-hospital mortality was lower in patients with PSF compared with patients with systolic dysfunction (2.8% vs. 3.9%; adjusted odds ratio OR: 0.86; p = 0.005), but duration of intensive care unit stay and total hospital length of stay were similar. Serum creatinine >2 mg/dl was associated with increased in-hospital mortality in both systolic function groups (PSF: 4.8%; systolic dysfunction: 8.4%; p 37 mg/dl (OR: 2.53; 95% confidence interval CI: 2.22 to 2.87) and systolic blood pressure < or =125 mm Hg (OR: 2.58; 95% CI: 2.33 to 2.86). CONCLUSIONS Heart failure with PSF is common and is characterized by a unique patient profile. Event rates are worrisome and reflect a need for more effective management strategies.