Clinical characteristics of hospitalized heart failure patients with preserved, mid‐range, and reduced ejection fractions in Japan

Abstract

Aims There are regional differences in the patient characteristics, management, and outcomes of hospitalized patients with heart failure (HF). The aim of this study was to evaluate the clinical characteristics and outcomes of Japanese patients who are hospitalized with HF on the basis of the left ventricular ejection fraction (LVEF) stratum. Methods and results We retrospectively conducted a multicentre cohort study of 1245 hospitalized patients with decompensated HF between 2013 and 2014. Of these patients, 36% had an LVEF < 40% [HF with reduced ejection fraction (HFrEF), median age 72 years, 71% male], 21% had an LVEF 40–49% [HF with mid‐range EF (HFmrEF), 77 years, 56% male], and 43% had an LVEF ≥ 50% [HF with preserved EF (HFpEF), 81 years, 44% male]. The primary outcome was death from any cause, and the secondary outcomes were cardiac death and re‐hospitalization due to worsened HF after hospital discharge. There were high proportions of non‐ischaemic cardiomyopathy (32%) in HFrEF patients, coronary artery disease (44%) in HFmrEF patients, and valvular disease (39%) in HFpEF patients. The frequencies of intravenous diuretic and natriuretic peptide administration during hospitalization were 66% and 30%, respectively. The median hospital stay for the overall population was 19 days, and the length of stay was >7 days for >90% of patients. In‐hospital mortality was 7%, but was not different among the LVEF groups (HFrEF 7%, HFmrEF 6%, and HFpEF 8%). After a median follow‐up of 19 months (range, 3–26 months), 192 (17%) of the 1156 patients who were discharged alive died, and 534 (46%) were re‐hospitalized after hospital discharge. There were no significant differences in mortality after hospital discharge among the three LVEF groups (HFrEF 18%, HFmrEF 16%, and HFpEF 16%). There were no differences in cardiac death or re‐hospitalization due to worsened HF after hospital discharge among the LVEF groups (cardiac death: HFrEF 8%, HFmrEF 7%, and HFpEF 7%; re‐hospitalization due to worsened HF: HFrEF 19%, HFmrEF 16%, and HFpEF 17%). Multivariable‐adjusted analyses showed that the HFmrEF and HFrEF groups, compared with the HFpEF group, were not associated with an increased risk for in‐hospital death or death after hospital discharge. Non‐cardiac causes of death and re‐hospitalization after hospital discharge accounted for 35% and 38%, respectively. Conclusions Our results revealed different clinical characteristics but similar mortality rates in the HFrEF, HFmrEF, and HFpEF groups. The most common cause of death and re‐hospitalization after hospital discharge was HF, but non‐cardiac causes also contributed to their prognosis. Integrated management approaches will be required for HF patients.

Clinical Predictors Influencing the Length of Stay in Emergency Department Patients Presenting with Acute Heart Failure

“…In terms of gender, our patients were predominantly male (62%), which was in concordant to the proportion of male patients in EHFS II (61%) and HIJ-HF II (71%). Less than half of the patients had reduced ejection fraction (23.1%), which is also consistent with proportions reported from studies in the US (46%) [ 28 ] and Japan (36%) [ 31 ]. Interestingly, the character of our study patients was quite different from the data reported by the Thai ADHERE study in 2010 [ 13 ].…”

Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19

“…Despite substantial evidence pointing to equivalent outcomes in other settings, patients with HFpEF are often considered at lower risk for mortality compared with their HFrEF counterparts. The present analysis added to this mounting body of literature ( 24 , 25 ), which demonstrated similar outcomes among patients with HFpEF and HFrEF, even in the setting of acute COVID-19. In contrast, our results suggested that patients with HFmrEF could have a better prognosis, because they can represent a distinct and more favorable HF phenotype ( 26 , 27 ).…”

Clinical, Echocardiographic, and Therapeutic Characteristics of Heart Failure in Patients with Preserved, Mid-Range, and Reduced Ejection Fraction: Future Directions

“…Despite different designs and sample size, the major international studies (CHARM Program, 13 , 14 Framingham Heart study, 15 ESC HF long-term registry, 16 Swedish Heart Failure registry, 17 China Heart Failure Center Registry, 18 and others 19 have demonstrated similar findings. Overall, however, the Saudi patients were younger with a mean age of 62.7 years, as compared with other studies that had a cumulative age range of 65–82 years.…”