Characterization of Patients with Heart Failure with Recovered Ejection Fraction From an Urban, Inner City Teaching Hospital

Abstract

Background: Heart failure with recovered ejection fraction (HFrecEF) is an emerging clinical subgroup of patients with previous heart failure with reduced ejection fraction (HFrEF) that have recovered their EF. It is important to identify predictors of recovery and the impact of contributing comorbidities to define the optimal medical management. The aim of this study was to identify clinical phenotypes of patients with HFrecEF in a large inner city teaching hospital. Methods: We conducted a retrospective chart review of patients admitted to the University of Florida Jacksonville hospital with a diagnosis of heart failure with reduced ejection fraction (HFrEF) from January 1, 2009 December 31, 2015. Patients 18 years or older had to have at least 2 echocardiograms within the study period with the initial EF <40%. The diagnosis of HFrecEF was defined as the most recent LVEF ≥40% and a previously documented LVEF <40%. Results of echocardiograms and etiology of HF as well as documentation of age, gender, race, body mass index, hypertension (HTN), hyperlipidemia, coronary artery disease (CAD), diabetes mellitus (DM) were analyzed. The diagnosis of ischemic cardiomyopathy was defined as a decrease in ejection fraction that can be explained by the presence of significant CAD diagnosed by catheterization or non invasive testing (functional or anatomic). Results: A total of 6459 patients were included in the study. Of these 921(14.2%) met criteria for HFrecEF. Twenty-one patients had missing data and were excluded from the analysis. The median age of patients with HFrecEF was 67.5 years, 58% (522 of 900) were male, 50.5% (545 of 900) were White and 45.5% (410 of 900) were Black, 36% (327 of 900) were diagnosed with ischemic cardiomyopathy. 36.3% had DM, 41.9% had CAD, 70.7% had HTN, with highest prevelence in Blacks (87%). 23.8% (214 of 900) received an implantable cardioverter defibrillator (ICD) for primary prevention. 3% (27 of 900) received cardiac resynchronization therapy (CRT). Conclusions: HFrecEF in urban, inner city teaching hospital is a diverse, heterogeneous group with different comorbidity profiles and etiologies of cardiomyopathy across different racial groups. Non ischemic etiology and hypertensive disease are most common in blacks whereas ischemic etiology is predominant in whites. Further investigations to determine the natural history, risk stratification and predictors of EF recovery are necessary to establish optimal medical management of this subgroup of patients.