Abstract 15532: Characteristics and Outcomes of Patients With Heart Failure With Reduced Ejection Fraction and a Worsening Heart Failure Event

Abstract

Background: Several recent heart failure trials enrolled patients with heart failure with reduced ejection fraction (HFrEF) who had a worsening heart failure (WHF) event. Aim: To describe the characteristics and outcomes of patients with HFrEF and a WHF event at a large tertiary medical center. Methods: We identified patients 18-85 years of age with chronic symptomatic HFrEF (EF ≤35% and ≥2 HF encounters in the prior 18 months) treated at Duke University between Jan 2009-Dec 2018 through the Duke Echo Lab Database. A WHF event was defined as either a hospitalization or ED visit for HF in the prior 12 mos. A set of exclusion criteria [e.g., renal dysfunction, left ventricular assist device (LVAD), heart transplant] were applied to patients with a WHF event to generate a patient cohort similar to those enrolled in contemporary HF trials. We did not restrict the cohort based on BP or BNP levels since these vary over time. Baseline characteristics and outcomes including death and hospitalization were assessed. Results: Of 4846 unique patients with HFrEF, 3668 (76%) had a WHF event in the year prior to index echo. Sequentially, patients with GFR <20 mL/min/1.73 m 2 (n=458), LVAD (n=291), or heart transplant (n=95) were excluded; 2824/4846 (58%) remained in the WHF study population. HFrEF patients with WHF were typically men (68%) with median age of 65 years (IQR 54, 73) and low EF (EF <25% in 57%). Coronary disease (71%), diabetes (44%), and elevated NT-proBNP (median 2405 pg/mL [698, 6841]) were common. Beta-blocker, ACEi/ARB, and MRA use were 88%, 79% and 44%, respectively. HFrEF patients with WHF had a high 30-day, 1-year, and 5-year cumulative incidence of all-cause mortality and HF hospitalization after index echo (FIGURE). Conclusions: In patients with chronic HFrEF at Duke University, 76% had a WHF event in the past year and 58% met several of the key eligibility criteria of contemporary HF trials. Patients with recent WHF had a high burden of comorbidities and very high event rates.