A retrospective cohort study on clinical characteristics of heart failure patients with HFrEF, HFmrEFand HFpEF in geriatrics of Northeastern China

Abstract

Background: Heart failure (HF) has been considered as one of the leading cardiovascular disease with high morbidity and high mortality in the world. However, there is a lack of analysis on the clinical characteristics of different types of elderly HF patients in geriatrics of Northeastern China.We conducted this single-center, retrospective study to evaluate the clinical characteristics of HF patients with mid-range(HFmrEF), preserved (HFpEF) and reduced ejection fraction (HFrEF) in a Chinese cohort. Methods: The study was conducted on 1230 patients of age 60 or above, with HF from Jan. 02, 2014 to May 03, 2018 hospitalized in geriatrics department, the First Affiliated Hospital of China Medical University. All the patients met the definition for HFrEF, HFmrEF and HFpEF according to 2016 European Society of Cardiology (ESC) guidelines.Targeted variables including demographics, vital signs, comorbidities and lab assessment results were compared among the three groups by Pearson’s χ2 test, and multivariate logistic regression analyses were performed for risk factor exploration on the three types of HF. Results:Of the 1230 patients included (78.28±9.0years, 67.15%male), there are 93 patients with HFrEF(7.5%), 56 patients with HFmrEF (4.5%) and 1081 patients with HFpEF (87.8%). Compared to patients with HFpEF, those with HFmrEF were more likely to have comorbid acute myocardial infarction, infection and coronary artery disease, had higher level of N-terminal pro B-type natriuretic peptide (NT-proBNP), cardiac troponin, blood urea nitrogen (BUN), white blood cell (WBC). And patients with HFpEF were more frequently to be female, to be older, and to have comorbid peripheral artery disease, but less frequently had AMI, CAD and kidney disease than those with HFrEF. However, patients with HFmrEF had no significant difference from those with HFrEF. Multivariable analysis showed that comorbid atrial fibrillation,AMI and infection were associated with HFmrEF (p<0.05), whereas female, old age, comorbid hypertension,and PAD were associatedwithHFpEF, and CAD,kidney disease were associated with HFrEF (p<0.05). Conclusions:The results of our study supported that patients with HFmrEF were closer to patients with HFrEF in respect to most of the demographics andclinical characteristics observed, while showing certain differences from patients with HFpEF. Trial registration: The study was approved by the local ethics committee from the First Affiliated Hospital of China Medical University(#2020232,July 13,2020).