Comparison of Clinical Features and Outcomes of Patients Hospitalized With Heart Failure and Normal Ejection Fraction (≥55%) Versus Those With Mildly Reduced (40% to 55%) and Moderately to Severely Reduced (<40%) Fractions

Abstract

Heart failure (HF) with normal ejection fraction (EF) is an increasingly common presentation of acute decompensated heart failure (ADHF). Differences between patients with HF and truly normal EF and those with mildly impaired EF have not been described. The Acute Decompensated Heart Failure Registry (ADHERE) contains information on over 100,000 heart failure hospitalizations and may provide insight into this distinction. The ADHERE database was used to investigate differences between patients hospitalized with heart failure and severely (EF < 25%), moderately (EF 25-40%) and mildly reduced ejection fraction (EF 40-55%) vs. those with normal ejection fraction (EF ≥ 55%). The group with normal EF was 69% female with a mean age of 74 (p<0.017 vs. all other groups). Coronary artery disease was less frequent in the normal EF group, and hypertension played a larger role. Patients with EF ≥ 55% had elevated pulse pressure, suggesting a role for arterial stiffening. Treatment differed by ejection fraction. Creatinine increased ≥ 0.5 mg/dl more often in the group with HF and normal EF than the group with HF and severely reduced EF. In-hospital mortality and intensive care unit length of stay varied inversely with ejection fraction; overall length of stay was similar. In conclusion, patients with HF and normal EF are more likely to be female, have a history of high pulse pressure hypertension, less coronary artery disease and a lower risk of inpatient death but a higher likelihood of deterioration in renal function during hospitalization. These observations may be important considerations in the design of future clinical trials. Studies of heart failure with normal ejection fraction (EF) utilize widely varying EF definitions from ≥ 40% to >55%. 1-3 This broad range may obscure important results by mixing different patient populations, particularly because patients with an EF in the 40-55% range may have both left ventricular (LV) systolic and diastolic abnormalities. Even patients with heart failure (HF) and normal EF, long thought to have normal LV systolic function with a primary

Cardiorenal Syndrome

“…With the observation that many patients hospitalized with evidence of acute CRS have preserved or even elevated BP and normal left ventricular ejection fraction (6), some studies have noted the importance of renal congestion or renal venous hypertension and raised intra-abdominal pressure (7,8). Others have identified changes in systolic BP rather than cardiac index or right atrial pressure as being predictive of changes in kidney function (9).…”

Characteristics and Outcomes of Hospitalized Patients With Heart Failure and Reduced vs Preserved Ejection Fraction A Report From the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)

“…17 The ADHERE database included more than 100,000 patients hospitalized with HF and showed that 50.4% had EF ≥40% and 22.7% had ≥55%. 6,18 In OPTIMIZE-HF registry, including 48,612 patients hospitalized for HF, 41,267 (84.9%) had data for EF or a qualitative LV function assessment and, of the patients with LV function assessed, 21,149 (51.2%) had EF ≥40% or a qualitatively normal/mildly impaired EF. 7 Even though the definitions for preserved EF have varied and the appropriate EF cut-off values have not been established, the previous findings were mostly similar to our present results.…”

“…6,7,17,18 Euro Heart Failure Survey reported that 3,148 out of 6,806 patients (46.3%) had HF and preserved systolic function. 17 The ADHERE database included more than 100,000 patients hospitalized with HF and showed that 50.4% had EF ≥40% and 22.7% had ≥55%.…”

Prognostic Factors in Patients Hospitalized for Heart Failure

“…In the United States, the incidence of HFH due to HFpEF has been increasing over time, accounting for 50-55 % of all HFH in the most current statistics [7,13,16,17,[21][22][23]. Similarly, earlier European data from EHFS I suggested that 55 % of HFH were due to HFpEF [12,14], although, more recently, EHFS II has put that number much lower at 34 % [15].…”