Abstract 149: Long-term Survival after Heart Failure Hospitalization: Comparison of Those with vs. without Reduced LVEF

Abstract

Background: Heart failure (HF) is associated with high mortality, but the major focus of HF care has been on those with reduced left ventricular (LV) ejection fraction (HFrEF). We sought to determine whether or not HF with preserved EF (HFpEF) was associated with better long-term survival than HFrEF. Methods: We studied 999 Veterans hospitalized for HF from January 2004 to December 2009. Baseline characteristics examined were co-morbidities, ECG, labs, medications and ECHO LVEF. Univariate analyses compared baseline characteristics. Significance was defined as p-value <0.05. Survival in the two groups was compared with a Kaplan-Meier survival plot employing a log-rank test. Results: Of the 999, 540 (54%) had HFrEF (<40%), while 459 (46%) had HFpEF (>=40%). HFpEF patients were significantly older (73.2 vs. 70.7 yrs), had significantly more HTN (72% vs. 59%), diabetes (51% vs. 42%), anemia (27% vs. 18%), COPD (24% vs. 19%), obesity (17% vs. 10%), and had significantly higher creatinine (1.7 vs. 1.5) and lower hemoglobin (11.8 vs. 12.9). The HFrEF group had significantly lower LVEF (24% vs. 53%), higher BNP (1,344 vs. 646), more prior HF (31% vs. 24%), a trend toward more CAD (47% vs. 41%; p =0.07), higher troponin (0.49 vs. 0.12), higher heart rate (89 vs. 79 bpm) and wider QRS duration (125 vs. 108 msec). Survival in the overall group was 94%, 71%, 60%, and 51% at 30 days, 1 year, 2 years and 3 years, respectively. The plot shows that both HFrEF (solid line) and HFpEF (dashed line) are associated with reduced survival ~50% at 3 years. The trend toward worse survival for HFrEF was not significant (log rank p = 0.17). Conclusion: HFpEF is not a benign entity.Our observations are consistent with HFpEF being driven by diastolic dysfunction and/or pulmonary HTN relating to HTN, COPD, and obesity, whereas HFrEF results from structural heart damage and loss of myocardium (higher troponin, higher heart rate and wider QRS) along with a trend toward more CAD.