Rehospitalization, mortality and associated variables in primary care patients with heart failure and preserved ejection fraction after first hospitalization

There is a paucity of studies providing insights into the progression of primary care patients with heart failure and preserved ejection fraction (HFpEF). To investigate the characteristics associated with mortality and rehospitalizations in primary care patients with heart failure and preserved ejection fraction (HFpEF), previously hospitalized. Retrospective cohort study that included primary care patients with previous heart failure (HF) hospitalization and ejection fraction ≥ 50 of 328 primary care centers of Catalonia. Demographic, comorbidities, clinical, and treatment variables were collected. Outocomes: Mortality and HF rehospitalization. Adjusted Cox regression models were performed. Study included 2,895 patients. Mean age was 77(SD 9.7) years, 57% were female. Mean follow up was 2.0[1.0 – 9.0] years. A total of 864(29.8%) patients died, 831(28.7%) were hospitalized. Mortality was associated with male sex(HR 1.26, 95% CI 1.06–1.49), age > 75 years(HR 2.76, 95% CI 2.24–3.39), Charlson Index(HR 2.03, 95% CI 1.21–3.42), body mass index(BMI) ≤30 kg/m 2 (HR 1.44, 95% CI 1.22–1.69) and loop diuretics(HR 1.36, 95% CI 1.11–1.65); hemoglobin levels(HR 0.87, 95% CI 95% 0.82–0.91) were protective. HF rehospitalization was associated with male sex(HR 1.14, 95% CI 1.03–1.33), age > 75 years(HR 1.37, 95% CI 1.17–1.61), atrial fibrillation(HR 1.44, 95% CI 1.25–1.67), and loop diuretics(HR 1.37, 95% CI 1.15–1.63). Hemoglobin(HR 0.91, 95% CI 0.87–0.95) were protective. High proportion of HFpEF patients were hospitalized or died at 5 years follow up. Comorbidities, demographic, analytical and treatment variables played a relevant role as prognostic factors. Graphic Summary: Heart failure and preserved ejection fraction registry in a real-life Mediterranean cohort. Patients with a HF hospital discharge diagnosis and an EF ≥ 50% from a public database were included.ACEi:angiotensin-converting enzyme inhibitors; AF: atrial fibrillation; ARB:angiotensin II receptor blockers, BMI: body mass index; EF: ejection fraction; eGFR: estimated glomerular filtration rate; HF: heart failure; HT: hypertension; LVEF: left ventricular ejection fraction; SIDIAP: Information System for the Development of Research in Primary Care; T2DM; type 2 diabetes mellitus • Current evidence in this field have shown: • Heart failure with preserved ejection fraction (HFpEF) is the most common phenotype of heart failure in patients attended in primary care. • Some European studies have shown a high morbidity and mortality in these patients, relating to age, male sex and some comorbidities. • There is scarce information on mortality, rehospitalizations and associated variables in the Mediterranean region. • Our study contributes the following aspects to this area: • Our cohort showed a greater percentage of patients >75 years and a greater proportion of women, as well as higher prevalence of obesity, type-2 • Mortality in our study was lower than in other studies from Northern Europe. • Relating variables with mortality were: age, male sex, treatment with loop diuretics, Charlson Index> 4 and BMI ≤30 kg/m 2 .