Decompensated Heart Failure with Mid-Range Ejection Fraction: Epidemiology and In-Hospital Mortality Risk Factors

Abstract

Background: Recently, a new HF entity, with LVEF between 40-49%, was presented to comprehend and seek better therapy for HF with preserved LVEF (HFpEF) and borderline, in the means that HF with reduced LVEF (HFrEF) already has well-defined therapy in the literature. Objective: To compare the clinical-therapeutic profile of patients with HF with mid-range LVEF (HFmrEF) with HFpEF and HFrEF and to verify predictors of hospital mortality. Method: Historical cohort of patients admitted with decompensated HF at a supplementary hospital in Recife/ PE between April/2007-August/2017, stratified by LVEF (< 40%/40-49/≥ 50%), based on the guideline of the European Society of Cardiology (ESC) 2016. The groups were compared and Logistic Regression was used to identify predictors of independent risk for in-hospital death. Results: A sample of 493 patients, most with HFrEF (43%), HFpEF (30%) and HFmrEF (26%). Average age of 73 (± 14) years, 59% men. Hospital mortality 14%, readmission within 30 days 19%. In therapeutics, it presented statistical significance among the 3 groups, spironolactone, in HFrEF patients. Hospital death and readmission within 30 days did not make difference. In the HFmrEF group, factors independently associated with death were: valve disease (OR: 4.17,

The Ejection Fraction Returns to Hyde Park Session's Speakers' Corner

“…Cavalcanti et al, 7 presented a frequency of 26% of patients with HFmrEF, as well as other characteristics consistent with those recently described in the literature. 6,8,9 It is very important that we know this characterization, because the answer on how to treat depends on it.…”

“…It is important to have the demographic and clinical portrait of HFpEF and HFmrEF. The paper presented by Cavalcanti et al, 7 is an important contribution to one of the obscure areas of HF. We do hope that the debate at the Hyde Park session should be based on evidence such as the one presented by Cavalcanti et al 7…”

“…The still very high 30-day mortality and readmission rates presented by Cavalcanti et al, 7 make it mandatory that we improve the approach to HF as a whole, independent of LVEF. It is important to have the demographic and clinical portrait of HFpEF and HFmrEF.…”

“…The paper published by Cavalcanti et al, 7 in the International Journal of Cardiovascular Sciences draws a picture of 493 patients admitted for decompensated HF in the northeast region of Brazil over a 10-year period. Then, it compares the three strata defined by the ESC: reduced, mid-range and preserved.…”

“…The HFrEF prescription, very well grounded in large clinical trials or the therapeutic uncertainties of HFpEF. Cavalcanti et al, 7 show data that should reflect the reality of a tertiary or quaternary referral hospital in a population with a higher socioeconomic level. We should contextualize this.…”