A short and long-term outcomes of heart failure with midrange and preserved ejection fraction; developing countries perspective

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Hospitalization and mortality are common among patients with heart failure (HF). However, evidence of outcomes in HF patients classified by left ejection fraction (LVEF) is limited, especially in Thailand. Methods This is a single center retrospective study of patients who were hospitalized with acute HF from June 2017 to June 2019. The patient was identified by ICD coding and justified by Framingham Criteria. Patients’ characteristics, treatments and outcomes were gathered. The patients were classified by LVEF into reduced ejection fraction (HFrEF; <40%), midrange ejection fraction (HFmrEF; 40-49%) and preserved ejection fraction (HFpEF; ≥50%) groups. In-hospital mortality, length of stay and 1-year all cause death and re-hospitalization were collected. Pearson’s chi-square and one-way ANOVA were used to analyze the data. Results A total of 773 patients were screened and 668 patients with known LVEF were enrolled (mean age of 69.2 ± 15.0 years, 49.5% male, mean LVEF of 46.9 ± 19.3%). There were 279, 67, and 322 patients in HFrEF, HFmrEF and HFpEF groups, respectively. The patients with HFpEF were more likely to be female, elderly and less likely to have history of myocardial infarction (p <0.05). Neurohormonal blockages were more commonly prescribed in HFrEF. Overall, the in-hospital and 1-year mortality rate were 5.9% and 22.4%, respectively, which is not different between groups (p = 0.4). Overall, the length of stay was 12 days and not significantly different between groups (11.4 ± 11.3 vs. 13.7 ± 22.4 vs. 12.9 ± 17.8 for HFrEF, HFmrEF and HFpEF; p = 0.4). However, the 30 day-rehospitalization was still significantly higher in HFrEF compare to HFmrEF or HFpEF (31.3 vs. 17.2%, vs.19.9%, p = 0.003). Conclusion More than half of patients hospitalized for acute HF had HFpEF. The outcomes were poor regardless of LVEF groups. In this single center study, mortality was higher than that previously reported from developed countries registries. Therefore, awareness of poor outcomes is needed all HF patients regardless of LVEF.