Epidemiology and clinical characteristics of hospitalized heart failure patients with a reduced, mildly reduced and preserved ejection fraction

Rywik, Tomasz; Doryńska, Agnieszka; Wiśniewska, Anna; Cegłowska, Urszula; Drohomirecka, Anna; Łazarczyk, Hubert; Połaska, Paula; Leszek, Przemysław; Zieliński, Tomasz

doi:10.20452/pamw.16227

Cited by 11 publications

(21 citation statements)

References 23 publications

(99 reference statements)

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“…Compared with HFrEF, patients with HFmrEF or HFpEF were older, more commonly women, with more atrial brillation, but less ischemic heart disease. These differences in the clinical pro le between HF subgroups have also been observed by others [19,20,[28][29][30]. As these differences may have an impact on the clinical course of patients with HF, it is important to ascertain whether HCRU and healthcare costs may vary according to the type of HF, as well.…”

Section: Discussionsupporting

confidence: 55%

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Healthcare resource utilization and costs among patients with heart failure with preserved, mildly reduced, and reduced ejection fraction in Spain

Escobar

Palacios

Varela

et al. 2022

Preprint

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Aims To describe healthcare resource utilization (HCRU) of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Methods Adults with ≥ 1 HF diagnosis and ≥ 1 year of continuous enrolment before the corresponding index date (1/January/2016) were identified through the BIG-PAC database. Rate per 100 person-years of all-cause and HF-related HCRU during the year after the index date were estimated using bootstrapping with replacement. Results 21,297 patients were included, of whom 48.5% had HFrEF, 38.6% HFpEF and 4.2% HFmrEF, with the rest being of unknown EF. Mean age was 78.8 ± 11.8 years, 53.0% were men and 83.0% were in NYHA functional class II/III. At index, 67.3% of patients were taking renin angiotensin system inhibitors, 61.2% beta blockers, 23.4% aldosterone antagonists and 5.2% SGLT2 inhibitors. Rates of HF-related outpatient visits and hospitalization were 968.8 and 51.6 per 100 person-years, respectively. Overall, 31.23% of patients were hospitalized, mainly because of HF (87.88% of total hospitalizations); HF hospitalization length 21.06 ± 17.49 days (median 16; 25th, 75th percentile 9–27). HF hospitalizations were the main cost component: inpatient 73.64%, pharmacy 9.67%, outpatient 9.43%, and indirect cost 7.25%. Rates of all-cause and HF-related HCRU and healthcare cost were substantial across all HF subgroups, being higher among HFrEF compared to HFmrEF and HFpEF patients. Conclusions HCRU and cost associated with HF are high in Spain, HF hospitalizations being the main determinant. Medication cost represented only a small proportion of total costs, suggesting that an optimization of HF therapy may reduce HF burden.

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Section: Discussionsupporting

confidence: 55%

“…Although some studies have analyzed the clinical pro le and management of HF strati ed by EF (HFrEF, HF with mildly reduced EF [HFmrEF] and HFpEF) [19][20][21], there are very few studies that have focused on identifying cost drivers according to HF phenotype [22][23][24][25].…”

Section: Methodsmentioning

confidence: 99%

Healthcare resource utilization and costs among patients with heart failure with preserved, mildly reduced, and reduced ejection fraction in Spain

Escobar

Palacios

Varela

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…In contrast, patients with HFrEF had more atherosclerotic cardiovascular disease. Other studies have some similar differences in the clinical profile, except for hypertension, which is usually more common among patients with HFpEF [ 19 , 20 , 24 , 25 , 36 ]. In fact, ischemic heart disease and hypertension are the most common causes of HFrEF and HFpEF, respectively [ 1 ].…”

Section: Discussionmentioning

confidence: 84%

“…Data from 1061 Japanese patients (median age 81 years) showed that 61% had HFpEF and 39% had HFrEF [ 24 ]. In another study that analyzed 2601 hospitalized HF patients (mean age 64 years), 62% had HFrEF, 25% had HFpEF, and 13% had HFmrEF [ 25 ]. Although some studies have reported that half of all patients with HF have HFpEF, all these data indicate that the prevalence of HFpEF is markedly associated with age.…”

Section: Discussionmentioning

confidence: 99%

“…However, few contemporary studies have estimated the incidence and prevalence of HF stratified by EF (HFrEF, HFpEF, and HF with mildly reduced EF-HFmrEF-) or are limited to some regions. Additionally, recent data about the clinical profile and management of patients with HF stratified by EF are scarce [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. As a result, to optimize the current approach of these patients, new data are warranted.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence, Characteristics, Management and Outcomes of Patients with Heart Failure with Preserved, Mildly Reduced, and Reduced Ejection Fraction in Spain

Cervantes

Palacios

Varela

et al. 2022

JCM

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Objective: To estimate the prevalence, incidence, and describe the characteristics and management of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Methods: Adults with ≥1 inpatient or outpatient HF diagnosis between 1 January 2013 and 30 September 2019 were identified through the BIG-PAC database. Annual incidence and prevalence by EF phenotype were estimated. Characteristics by EF phenotype were described in the 2016 and 2019 HF prevalent cohorts and outcomes in the 2016 HF prevalent cohort. Results: Overall, HF incidence and prevalence were 0.32/100 person-years and 2.34%, respectively, but increased every year. In 2019, 49.3% had HFrEF, 38.1% had HFpEF, and 4.3% had HFmrEF (in 8.3%, EF was not available). Compared with HFrEF, patients with HFpEF were largely female, older, and had more atrial fibrillation but less atherosclerotic cardiovascular disease. Among patients with HFrEF, 76.3% were taking renin-angiotensin system inhibitors, 69.5% beta-blockers, 36.8% aldosterone antagonists, 12.5% sacubitril/valsartan and 6.7% SGLT2 inhibitors. Patients with HFpEF and HFmrEF took fewer HF drugs compared to HFrEF. Overall, the event rates of HF hospitalization were 231.6/1000 person-years, which is more common in HFrEF patients. No clinically relevant differences were found in patients with HFpEF, regardless EF (50- < 60% vs. ≥60%). Conclusions: >2% of patients have HF, of which around 50% have HFrEF and 40% have HFpEF. The prevalence of HF is increasing over time. Clinical characteristics by EF phenotype are consistent with previous studies. The risk of outcomes, particularly HF hospitalization, remains high, likely related to insufficient HF treatment.

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Outcomes and factors associated with mortality in patients with atrial fibrillation and heart failure: FARAONIC study

Gómez Doblas,

Cepeda‐Rodrigo,

Agra Bermejo

et al. 2023

Clinical Cardiology

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BackgroundHeart failure (HF) and atrial fibrillation (AF) are common and coexistent conditions.HypothesisTo investigate the adverse events and mortality risk factors in patients with AF and HF treated with rivaroxaban in Spain.MethodsMulticenter, prospective and observational study with a follow‐up of 2 years, that included adults, with a diagnosis of nonvalvular AF and chronic HF, anticoagulated with rivaroxaban at least 4 months before being enrolled.ResultsA total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, the mean age was 73.7 ± 10.9 years, 65.9% were male, 51.3% had HF with preserved ejection fraction and 58.7% were on New York Heart Association functional class II. CHA2DS2‐VASc was 4.1 ± 1.5. During the follow‐up, 11.6% of patients died and around one‐quarter of patients were hospitalized or visited the emergency department, being HF worsening/progression the main cause (51.1%), with a 2.9% of thromboembolic events and 2.0% of acute coronary syndromes. Major bleeding occurred in 3.1% of patients, with 0.5% experiencing intracranial bleeding but no fatalities. Compliance with HF treatment was associated with a lower risk of death (hazard ratio: 0.092; 95% confidence interval: 0.03–0.31).ConclusionsAmong patients with HF and AF anticoagulated with rivaroxaban, incidences of thromboembolic or hemorrhagic complications were low. The most important factor for improving survival was compliance with HF drugs, what strengths the need for early treatment with HF disease‐modifying therapy and anticoagulation.

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Epidemiology and clinical characteristics of hospitalized heart failure patients with a reduced, mildly reduced and preserved ejection fraction

Cited by 11 publications

References 23 publications

Healthcare resource utilization and costs among patients with heart failure with preserved, mildly reduced, and reduced ejection fraction in Spain

Healthcare resource utilization and costs among patients with heart failure with preserved, mildly reduced, and reduced ejection fraction in Spain

Prevalence, Characteristics, Management and Outcomes of Patients with Heart Failure with Preserved, Mildly Reduced, and Reduced Ejection Fraction in Spain

Outcomes and factors associated with mortality in patients with atrial fibrillation and heart failure: FARAONIC study

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