Abstract 13338: Clinical Profile of Patients Hospitalized for Heart Failure With Severely Reduced Ejection Fraction: From the GWTG-HF Registry

Abstract

Introduction: Many patients with heart failure (HF) have severely reduced ejection fraction but do not meet threshold for consideration of advanced therapies (i.e., stage D HF). The clinical profile, outcomes, and management of these patients in US practice is not well described. Methods: We studied patients hospitalized for worsening chronic HF with reduced ejection fraction (HFrEF) ≤40% across 423 sites in the Get With The Guidelines® (GWTG)-HF registry admitted 2014 -2019. We excluded patients with heart transplantation or durable mechanical circulatory support, severe kidney disease (eGFR<20 mL/min/1.73 m 2 or dialysis), or missing critical data elements. Patients were grouped by EF (≤30% vs. 31-40%) and data were compared using absolute standardized differences. Results: Among 113,348 patients with HFrEF ≤40%, 78,589 (69%) had an EF≤30%. Compared with EF 31-40%, patients with EF≤30% tended to be younger, were less likely to be female, and more likely to be Black (Table). Patients with EF ≤30% had lower systolic blood pressure, but modestly higher eGFR and lower rates of atrial fibrillation and diabetes. Rates of guideline-directed medical therapy (GDMT) use at discharge were generally higher among those with EF≤30%, including greater use of triple therapy (ACEI/ARB/ARNI + beta-blocker + MRA). Among 20,387 patients age ≥65 years linked to Medicare, compared with patients with EF 31-40%, patients with EF≤30% faced higher rates of 12-month mortality and HF hospitalization, but similar rates of all-cause hospitalization. Conclusions: Among patients hospitalized for worsening chronic HFrEF in US clinical practice, most patients have severely reduced EF≤30%. Despite modestly higher use of GDMT at discharge and younger age, patients with severely reduced EF face heightened post-discharge risk of death and HF hospitalization.