Hospitalization and mortality in heart failure with preserved ejection fraction: real-world data from a US integrated healthcare delivery system

Introduction Heart Failure with preserved ejection fraction (HFpEF) is a major public health and economic burden, but large real-world incident rates of clinical outcomes are scarce. Purpose Calculate adjusted incidence rates of hospitalization and mortality in patients with HFpEF compared with heart failure with reduced ejection fraction (HFrEF) using an integrated healthcare delivery System in the United States. Methods Non-interventional longitudinal cohort analysis between 2005 and 2017 of existing data of adult patients with a HF diagnosis (ICD9/ICD10) in the electronic medical record of Kaiser Permanent Northwest. Clinical outcomes of interest were all-cause hospitalizations, heart failure hospitalization (HHF, defined as a discharge diagnosis of HF in the primary position) and all-cause mortality. Age/sex adjusted incidence rates were assessed generalized estimating equations over 15 years of follow-up (2005–2019). Results Of the 37,773 patients with HF diagnosis, 36% had no EF available. 46.4% were categorized as HFpEF, 7.2% HFmrEF and 10.4% HFrEF. Compared with patients with HFrEF, those with HFpEF were older (72.1 vs. 68.3 years), more likely to be female (55% vs. 33.2%), had higher BMI (31.9 vs. 29.3 kg/m2), higher SBP (130 vs. 121mmHg) and were less likely to have a history of myocardial infarction (26.1% vs. 43.8%). Patients with HFpEF were less likely to receive RAAS blockade compared with HFrEF (66.0% vs. 86.7%) but use of any HF-related medication (ACE/ARB, diuretics, β-blockers, or aldosterone agonists) was similarly high (89.6% vs 88.8%). As shown in Figure 1, adjusted mortality rates per 1,000 person-years, [95% CI] were lower in HFpEF (107.9 [105.5, 110.3]) vs. HFrEF (143.0 [136.5, 149.7]). Also, HHF were lower in HFpEF (41.6 [40.1, 43.2]) compared to HFrEF (72.6 [67.7, 77.9]). All-cause hospitalization rates were about 12% lower in HFpEF (197.3 [193.9, 200.7]) compared with HFrEF (222.8 [214.1, 231.7]). Nonetheless, due to the much larger size of the HFpEF group, these patients generated 1,982 more HHF, 10,427 more hospitalizations for any reason, and 6,723 more deaths during follow-up. Conclusions In a large real-world dataset of HF patients, incidence rates for hospitalization and mortality were relatively lower in HFpEF vs. HFrEF. However, given the greater prevalence of HFpEF (46.4% vs. 10.4% for HFrEF), this diagnosis posed a much higher public health burden. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim