Abstract 13309: Differences in Clinical Characteristics and Hospitalizations Between Midrange, Reduced and Preserved Heart Failure

Abstract

Introduction: Distinct pathophysiologic differences exist among heart failure (HF) patients depending on baseline left ventricular ejection fraction (LVEF) and degree of LVEF recovery to medical therapy; however, differences in clinical outcomes among these patients remain unclear. Hypothesis: We hypothesized that patients with HF and mid-range EF (HFmrEF) would have lower all cause and HF hospitalizations compared to HFpEF and HFrEF patients. Methods: We identified 9,428 patients between 2009-2018 with ICD diagnosis of HF with a baseline and 1-year follow-up echocardiogram. We created 9 subgroups based on initial and follow-up ejection fraction (LVEF defined as preserved >50%; midrange 40-50% and reduced <40%). All-cause and HF hospitalizations crude incidence rates and length of stay were calculated as per patient follow-up year. Results: A total of 424 HFmrEF patients who maintained mid-range ejection fraction at follow-up were included in our analysis. HFmrEF patients were less likely to have pulmonary hypertension and more likely to have ischemic cardiomyopathy, coronary artery disease, hyperlipidemia compared to HFrEF and HFpEF (P <0.001). There were 47832 total and 18594 HF hospitalizations with a mean follow-up time of 3.89 years. Patients with HFmrEF who stay mid-range had the lowest number of total (0.97 per follow-up year, P<0.001) and HF hospitalizations (0.43, P<0.001) when compared to all other groups. HFmrEF who stay mid-range also had the lowest length of stay during both total and HF hospitalizations (2.85 and 1.91, P<0.001). Conclusions: Patients who have mid-range ejection fraction at diagnosis and at follow-up had lower all cause and HF hospitalizations and shorter length of stay when compared to HFrEF, recovered EF, and HFpEF patients. Further research is needed to determine the proper management of this group.