Is heart failure with mid range ejection fraction (HFmrEF) a distinct clinical entity or an overlap group?

Abstract

BackgroundThe new category of heart failure (HF), Heart Failure with mid range Ejection Fraction (HFmrEF) has recently been proposed with recent publications reporting that HFmrEF represents a transitional phase. The aim of this study was to determine the prevalence and clinical characteristics of patients with HFmrEF and to establish what proportion of patients transitioned to other types of HF, and how this affected clinical outcomes.Methods and resultsPatients were diagnosed with HF according to the 2016 ESC guidelines. Clinical outcomes and variables were recorded for all consecutive in-patients referred to the heart failure service. In total, 677 patients with new HF were identified; 25.6% with HFpEF, 21% with HFmrEF and 53.5% with HFrEF. While clinical characteristics and prognostic factors of HFmrEF were intermediate between HFrEF and HFpEF, HFmrEF patients had the best outcome, with higher mortality in the HFrEF population (p 0.02) and higher HF rehospitalisation rates in the HFpEF population (p < 0.01).38.7% of the HFmrEF patients transitioned (56.4% to HFpEF and 43.6% to HFrEF) with fewest deaths in the patients that transitioned to HFpEF (p 0.04), and fewest HF readmissions in the patients that remained as HFmrEF (<0.01)ConclusionHFmrEF patients had the best outcomes, compared to high rates of mortality seen in patients with HFrEF and high rates of HF readmissions seen in patients with HFpEF. Only 1/3 of HFmrEF patients transitioned during follow up, with the lowest mortality seen in patients transitioning to HFpEF.

Clinical features of heart failure with mid‐range and preserved ejection fraction in octogenarians: Results of a multicentre, observational study

“…The similar characteristics to those with HFpEF include older age, female sex, comorbidities (hypertension, chronic obstructive pulmonary disease, diabetes mellitus and laboratory values ‐BNP and troponin‐) and medication use (beta‐blockers, ACE‐Is and ARBs) . The characteristic in which the HFmrEF population was more similar to the HFrEF population was the comorbidity of coronary artery disease . In our study, 246 of the 1065 patients (23%) had HFmrEF.…”

“…26 The characteristic in which the HFmrEF population was more similar to the HFrEF population was the comorbidity of coronary artery disease. 25,27 In our study, 246 of the 1065 patients (23%) had HFmrEF. Of the 123 octogenarians, 30…”

“…Third, our study is also first in the literature analysing very elderly patients with HFmrEF. Previous studies have shown that patients with HFmrEF had clinical characteristics intermediate between those in the HFrEF and HFpEF groups . The similar characteristics to those with HFpEF include older age, female sex, comorbidities (hypertension, chronic obstructive pulmonary disease, diabetes mellitus and laboratory values ‐BNP and troponin‐) and medication use (beta‐blockers, ACE‐Is and ARBs) .…”

The Role of Adherence to Basic Pharmacotherapy of Heart Failure for Prevention of Late Adverse Events in Patients with Coronary Artery Disease and Left Ventricular Dysfunction After Surgical Revascularization of Myocardium

“…Expediency of prescribing ACEI/ARBs to patients with CAD after CABG is primarily determined by the presence of the baseline LVEF<40% [5,6] in most of them. Guidelines regarding the treatment of patients with HF mid-range EF are not that rigorous [17,18]. In this case history of MI, concomitant arterial hypertension, diabetes mellitus, and chronic kidney disease are likely to be the determining factors in favor of prescribing RAS blockers to CAD patients after CABG surgery [2][3][4][5][6][7]19].…”

“…neurohumoral modulators in the absence of a pronounced decrease in LV systolic function, as well as improvement or even restoration of LV systolic function in some patients with baseline LVEF <40% [6]. At the same time, taking into account the preservation of neurohumoral activation and the risk of further deterioration of LVEF (including the post-CABG one) [23,24], basic pharmacotherapy is potentially capable of modifying the course of the disease and slowing down the progression of HF in patients with LVEF in the «intermediate» range and among individuals who switched to the category of "restored" LV systolic function [17,25,27]. On the other hand, early interruption of the use of neurohumoral modulators may lead to the further decrease in LVEF and HF decompensation [28].…”