Plasma level of NT-proBNP is the most powerful prognostic factor in both HFpEF and HFrEF. Although patients with HFpEF have lower NT-proBNP levels, the prognosis of a patient with HFpEF expected from a given NT-proBNP level is similar with his/her counterpart with HFrEF.

Background and Objectives Heart failure (HF) is a disease with high morbidity and mortality. With ageing society and increasing prevalence of risk factors of HF, the prevalence of HF is expected to increase, as well. In this official report of the Korean Society of Heart Failure the epidemiology of HF in Korea is presented. Methods The data of Korean National Health Insurance big data, the Korean Heart Failure (KorHF) and the Korean Acute Heart Failure (KorAHF) registries have been used. Results In 2018, the prevalence, incidence, mortality of HF patients, and mortality due to HF were 2,261, 579, 245, and 10.4 per 100.000 persons, respectively. Regarding the temporal trend, there was a continuous increase in HF prevalence (0.77% in 2002, 1.48% in 2013, and 2.24% in 2018) and HF related deaths. The most common etiology for HF was ischemic origin, and the dominant subtype was HF with reduced ejection fraction (EF), defined as EF ≤40%. Of these, 77.6%, 58.0%, and 55.1% received renin-angiotensin-system inhibitors (angiotensin-converting-enzyme inhibitors or angiotensin-receptor-blockers), beta-blockers, and aldosterone-antagonists, respectively. In 2018, 1,542 implantable cardiac defibrillators and 272 cardiac resynchronization therapy devices were implanted, and 176 patients received heart transplantation. With improvement of pharmacologic and non-pharmacological therapy, the survival time of HF has been improving in the last 2 decades; nonetheless, it is associated with enormous increase in medical costs. Conclusions The prevalence of HF has been increasing in Korea. With improvement of therapy, the prognosis of HF has been improving, too. Nonetheless, appropriate interventions are necessary to prevent HF.

The application of a simple blood test to predict prognosis in acute heart failure (AHF) patients is not well established. Neutrophil-lymphocyte ratio (NLR) is inexpensive and easy to obtain in hospitalized patients using a routine blood test. We evaluate the prognostic implications of NLR as an independent predictor of in-hospital and long-term mortality in AHF patients. Among 5625 patients enrolled in the Korean Acute Heart Failure registry, 5580 patients were classified into quartiles by their NLR level, and analyzed for in-hospital and post-discharge three-year mortality. Patients in the highest NLR quartile had the highest in-hospital and post-discharge three-year mortality. The same results were seen by dividing the aggravating factor into the infection or ischemia group and the non-infection or non-ischemia group. For patients aggravated from infection or ischemia, a cut-off NLR value was 7.0 that increase the risk of in-hospital and post-discharge three-year mortality. In subgroups of patients not aggravated from infection or ischemia, a cut-off NLR value was 5.0 that increase the risk of in-hospital and post discharge three-year mortality. Elevated NLR in AHF patients at the index hospitalization is an independent predictor for in-hospital and post-discharge three-year mortality. Taken together, NLR is a marker for risk assessment of AHF patients.

BackgroundClinical practice guidelines have been slowly and inconsistently applied in clinical practice, and certain evidence-based, guideline-driven therapies for heart failure (HF) have been significantly underused. The purpose of this study was to survey guideline compliance and its effect on clinical outcomes in the treatment of systolic HF in Korea.Method and ResultsThe SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR) trial was a multi-center, retrospective, observational study on subjects with systolic HF (ejection fraction <45%) admitted to 23 university hospitals. The guideline adherence indicator (GAI) was defined as a performance measure on the basis of 3 pharmacological classes: angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), beta-blocker (BB), and aldosterone antagonist (AA). Based on the overall adherence percentage, subjects were divided into 2 groups: those with good guideline adherence (GAI ≥50%) and poor guideline adherence (GAI <50%). We included 1319 regional participants as representatives of the standard population from the Korean national census in 2008. Adherence to drugs at discharge was as follows: ACEI or ARB, 89.7%; BB, 69.2%; and AA, 65.9%. Overall, 82.7% of the patients had good guideline adherence. Overall mortality and re-hospitalization rates at 1 year were 6.2% and 37.4%, respectively. Survival analysis by log-rank test showed a significant difference in event-free survival rate of mortality (94.7% vs. 89.8%, p = 0.003) and re-hospitalization (62.3% vs. 56.4%, p = 0.041) between the good and poor guideline-adherence groups.ConclusionsAmong patients with systolic HF in Korea, adherence to pharmacologic treatment guidelines as determined by performance measures, including prescription of ACEI/ARB and BB at discharge, was associated with improved clinical outcomes.