Outcome of Heart Failure with Preserved Ejection Fraction: A Multicentre Spanish Registry

Abstract

Background:Studies on clinical features, treatment and prognosis of patients with congestive heart failure (CHF) and preserved left ventricular ejection fraction (LVEF) are few and their results frequently conflicting. Aims:To investigate the characteristics and long term prognosis of patients with CHF and preserved (≥ 45%) LVEF.Methods and Results:We conducted a prospective multicentre study with 4720 patients attended in 62 heart failure clinics from 1999 to 2003 in Spain (BADAPIC registry). LVEF was preserved in 30% patients. Age, female gender, prevalence of atrial fibrillation, hypertension and non-ischaemic cardiopathy were all significantly greater in patients with preserved LVEF. Mean follow-up was 40±12 months. Mortality and other cardiovascular complication rates during follow up were similar in both groups. On multivariate analysis ejection fraction was not an independent predictor for mortality. Survival at one and five years was similar in both groups (79% and 59% for patients with preserved LVEF and 78% and 57% for those with reduced LVEF, respectively).Conclusions:In the BADAPIC registry, a high percentage of heart failure patients had preserved LVEF. Although clinical differences were seen between groups, morbidity and mortality were similar in both groups.

Spectrum of epidemiological and clinical findings in patients with heart failure with preserved ejection fraction stratified by study design: a systematic review

“…It is interesting to note that, when analysed according to EF thresholds of 45–49% vs. 50–54% vs. ≥55% in community‐based studies, the overall mean prevalence of HFpEF (4.4% vs. 2.3% vs. 3.9%, respectively, and HFpEF as a percentage of all HF (43% vs. 53% vs. 73%, respectively) did not display clear trends. Similarly, when comparing HFpEF prevalence based on EF thresholds of 40–44% vs. 45–49% vs. 50–54% in registry studies, no clear trend was identified in HFpEF as a percentage of all HF (41% vs. 36% vs. 47%) …”

“…In the hospitalized HFpEF cohort, all‐cause mortality consistently increased by follow‐up year across regions; 5‐year mortality in hospitalized patients with HFpEF was ∼50–60%. Studies that did not report specific hospitalization status or with mixed cohorts showed greater variation in all‐cause mortality ( Figure B ), with mortality in two Japanese studies being among the lowest values reported and European studies tending to have the highest values …”

Ejection fraction and outcomes in patients with atrial fibrillation and heart failure: the Loire Valley Atrial Fibrillation Project

“…Previous studies have highlighted the considerable burden of HFPEF among HF patients, and several studies show that HFPEF carries similar mortality and morbidity to HFREF ,,. An increasingly important patient group appears to be those patients with HF with recovered EF, who are reported to have milder symptoms and fewer HF hospitalizations than both HFREF and HFPEF .…”

Survival of patients with chronic heart failure in the community: a systematic review and meta‐analysis

“…The pooled survival rates at 1 month, and 1, 2, 5 and 10 years, respectively, were 95.7% (95% confidence interval 94.3-96.9), 86.5% (85.4-87.6), 72.6% (67.0-76.6), 56.7% (54.0-59.4) and 34.9% Only 19 studies reported data on cause of death, but in 14 of these a cardiovascular cause accounted for over 50% of the total deaths ( Table 2). 25,26,34,45,47,[50][51][52][53]56,60,61,63,64,67,69,[72][73][74]77 HF tended to be the most frequent cause of death but there was significant variation in the reported proportion of deaths related directly to HF, ranging from 8% to 64%.…”