Recurrent hospitalizations are associated with increased mortality across the ejection fraction range in heart failure

Abstract

Aims The proportion of patients hospitalized for heart failure (HF) with preserved left ventricular ejection fraction (LVEF) is rising, but no approved treatment exists, in part owing to incomplete characterization of this particular HF phenotype. In order to better define the characteristics of HF phenotypes in Finland, a large cohort with 12 years' follow-up time was analysed. Methods and results Patients diagnosed between 2005 and 2017 at the Hospital District of Southwest Finland were stratified according to LVEF measure and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. For this retrospective registry study, previously diagnosed HF patients were defined as follows: patients with reduced ejection fraction (HFrEF; LVEF ≤ 40%; n = 4042), mid-range ejection fraction (HFmrEF; LVEF > 40-50% and NT-proBNP ≥ 125 pg/mL; n = 1468), and preserved ejection fraction (HFpEF; LVEF > 50% and NT-proBNP ≥ 125 pg/mL; n = 3122) and followed up for 15 022, 4962, and 10 097 patient-years, respectively. Cardiovascular (CV) hospitalization and mortality, influence of pre-selected covariates on hospitalization and mortality, and the proportion of HFpEF and HFmrEF patients with a drop in LVEF to HFrEF phenotype were analysed. All data were extracted from the electronic patient register. HFrEF patients were rehospitalized slightly earlier than HFpEF/HFmrEF patients, but the second, third, and fourth rehospitalization rates did not differ between the subgroups. Female gender and better kidney function were associated with reduced rehospitalizations in HFmrEF and HFrEF, with a non-significant trend in HFpEF. Each additional hospitalization was associated with a twofold increased risk of death and 2.2to 2.3-fold increased risk of CV death. All-cause mortality was higher in patients with HFpEF. Although CV mortality was less frequent in HFpEF patients, it was associated with increased NT-proBNP concentrations at index in all patient groups. During the 10 years following the index date, 26% of HFmrEF patients and 10% of HFpEF patients progressed to an HFrEF phenotype. Conclusions These findings suggest that disease progression, in terms of increased frequency of hospitalizations, and the relationship between increased number of hospitalizations and mortality are similar by LVEF phenotypes. These data highlight the importance of effective treatments that can reduce hospitalizations and suggest a role for monitoring NT-proBNP levels in the management of HFpEF patients in particular.

A retrospective cohort study on clinical characteristics of heart failure patients with HFrEF, HFmrEFand HFpEF in geriatrics of Northeastern China

“…In our study, HFpEF accounted for 87.8% of all HF patients included, while HFmrEF and HFrEF accounted for 4.5% and 7.5% respectively. The prevalence of HFmrEF 4.5% in our study was muchlower thanin other studies(16%,24% or 17%) [7][8][9].Previous studies were mostly based on the statistical results of patients with HF, or registered in hypertension, HF centers and other related data [10][11][12]. In contrast, this study was on inpatients of geriatrics department, so it is much more asymptotic to the incidence of HF in the elderly population, and will be more conducive to reminding geriatricians of identifying HF patients, and following up analysis on HFpEF patients with a large proportion, and exploring more factors affecting heart function to further guide the clinical treatment of HFpEF [5].The mean age of HF patients included was 78.28, higher than those reported in other studies [5],which could be explained by the fact that our patients were enrolled from the geriatric department of a hospital where usually older patients are admitted.Previous studies including older patients showed a higher frequency of HFpEF [13].…”

Recurrent heart failure hospitalizations increase the risk of cardiovascular and all‐cause mortality in patients with heart failure in Sweden: a real‐world study

“…The baseline characteristics of patients in the current study were in line with other studies evaluating the relationship of recurrent HFHs on mortality or re-admissions following incident HFH. 1,12,14,18 The results of this study should be interpreted in light of some limitations. First, our analysis included only patients with a 4 year clean period, which is reasonable to assume as the study identified actual first HFH.…”

Are HFpEF and HFmrEF So Different? The Need to Understand Distinct Phenotypes

“…Aside from clinical characteristics and presentation, a few discrepancies are related to the outcome and mode of death of this group: although some studies reported a similar mortality rate independently of EF, some authors revealed an intermediate clinical profile and risk between HFpEF and HFrEF, and there is a general agreement in considering the outcome of HFmrEF much more similar to HFpEF (21,22). Despite that CV events are considerably more in HFrEF, prognosis in those with HFmrEF is more strictly related to non-CV events and this tends to balance the overall mortality rate (23).…”