Fate of Acute Heart Failure Patients With Mid-Range Ejection Fraction

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Heart Failure with Mid-Range Ejection Fraction (HFmrEF) (n=3085). Intervention: Maintenance of renin-angiotensin system blockers (RASB) vs. No maintenance of RASB. Primary outcome: All-cause mortality (HR 0.309, 95% CI 0.162-0.588, p=<0.001).

Hye Bin Gwag; Ga-Yeon Lee; Jin-Oh Choi; Hae‐Young Lee; Jae‐Joong Kim; Kyung‐Kuk Hwang; Shung Chull Chae; Sang Hong Baek; Seok‐Min Kang; Dong‐Ju Choi; Byung‐Su Yoo; Kye Hun Kim; Hyun‐Young Park; Myeong‐Chan Cho; Byung‐Hee Oh; Eun‐Seok Jeon

doi:10.1253/circj.cj-17-1389

April 19, 2018Circulation JournalOpen Access

Fate of Acute Heart Failure Patients With Mid-Range Ejection Fraction

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Key result

Maintenance of renin-angiotensin system blockers was independently associated with a significantly lower risk of all-cause mortality (HR 0.309) in patients with acute heart failure and mid-range ejection fraction.

Study Design

Type

Cohort (n=3,085)

Multicenter

Yes

Structured PICO

P

Population

3,085 patients hospitalized for acute heart failure, including 454 with mid-range ejection fraction, followed for a median of 30.1 months to evaluate LVEF changes and mortality.

O

Outcome

Improvement of LVEF (defined as %LVEF change ≥5 and follow-up LVEF ≥50%) and all-cause mortalityhard clinical

Main Result

Hazard Ratio: 0.309 (95% CI 0.162–0.588)

p-value: p=<0.001

Limitations

Unmeasured confounding factors may not have been adequately controlled for due to the observational cohort design.
A significant portion of HFmrEF patients were excluded due to a lack of follow-up echocardiography data.
The study could not differentiate HFmrEF patients from those recovering from HFrEF.
Left ventricular mass data could not be investigated.
The precise reasons for lower maintenance of HF medications in patients with worsened LVEF could not be assessed.
Cause-specific mortality could not be assessed as survival data were confirmed using National Insurance data or National Death Records.
Unmeasured confounding factors may not have been adequately controlled for
Less than half of all the HFmrEF patients were excluded for a lack of follow-up echocardiography data
Could not differentiate HFmrEF patients from patients recovering from HFrEF
LV mass data could not be investigated
Precise reason that HFmrEF patients with worsened LVEF showed relatively lower maintenance of HF medications could not be assessed
Cause-specific mortality could not be assessed

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Implication

Approximately one-third of acute heart failure patients with mid-range ejection fraction show improved LVEF at follow-up, which is associated with better survival, and maintenance therapy with RASB or aldosterone antagonists independently predicts lower mortality.

Abstract

BACKGROUND: The outcomes of heart failure (HF) with mid-range ejection fraction (HFmrEF) have been rarely studied, and follow-up data on left ventricular ejection fraction (LVEF) are scarse. METHODS AND RESULTS: Patients were selected from a prospective multicenter registry of patients hospitalized for acute HF and then classified in the improved group if they exhibited %LVEF change ≥5 with follow-up LVEF ≥50%. Follow-up LVEF reported at least 90 days after discharge was used for classification. Of the 3,085 patients with acute HF, 454 were classified in the HFmrEF, and 276 had follow-up data. Of these 276 patients, 34.1% were classified in the improved group. Multivariate analysis revealed that hypertension, higher heart rate, lower serum sodium level, and maintenance therapy with β-blocker were associated with improved LVEF. The survival rate was significantly higher in the improved group than in the other groups. Young age and maintenance therapy with renin-angiotensin system blockers or aldosterone antagonists were significantly associated with better survival in HFmrEF. CONCLUSIONS: One-third of HFmrEF patients showed improved LVEF; moreover, the survival rate in the improved group was higher than the other groups. Renin-angiotensin system blockers and aldosterone antagonists could improve the survival of HFmrEF patients.

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Cite This Study

Gwag et al. (2018) conducted a cohort in Acute Heart Failure with Mid-Range Ejection Fraction (HFmrEF) (n=3,085). Maintenance of renin-angiotensin system blockers (RASB) vs. No maintenance of RASB was evaluated on All-cause mortality (HR 0.309, 95% CI 0.162-0.588, p=<0.001). Maintenance of renin-angiotensin system blockers was independently associated with a significantly lower risk of all-cause mortality (HR 0.309) in patients with acute heart failure and mid-range ejection fraction.

synapsesocial.com/papers/6a8d788e37479a8d604ac866 https://doi.org/10.1253/circj.cj-17-1389

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Fate of Acute Heart Failure Patients With Mid-Range Ejection Fraction

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Fate of Acute Heart Failure Patients With Mid-Range Ejection Fraction

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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