Abstract 17176: Burden and Prognostic Importance of Heart Failure Signs and Symptoms - Differences in Heart Failure With Preserved versus Reduced Ejection Fraction

Abstract

Introduction: In patients with heart failure (HF), worsening of HF signs and symptoms is associated with increased cardiovascular (CV) risk. Differences in burden of HF signs and symptoms and their prognostic value in HF with preserved (HFpEF) versus reduced ejection fraction (HFrEF) are poorly understood. Hypothesis: High burden of HF signs and symptoms is associated with adverse CV events, and is of greater prognostic value in patients with HFrEF. Methods: Using combined data from PARADIGM-HF (LVEF eligibility ≤40%) and PARAGON-HF (LVEF eligibility ≥45%), Cox models were fit to assess the relationship between burden of HF signs and symptoms (≤2 or ≥3) and first HHF or CV death in patients with HFrEF (n=8385) and HFpEF (n=4709) with available signs and symptoms at screening (rest dyspnea, exertional dyspnea, paroxysmal nocturnal dyspnea, orthopnea, fatigue, edema, jugular venous distension, rales, third heart sound). Results: High burden of HF signs and symptoms (≥3) was more common among patients with HFpEF (48%) than HFrEF (42%, p<0.001). In both HF types, patients with high burden of signs and symptoms were more commonly female, had higher NYHA functional class and NT-proBNP and were more frequently prescribed diuretics (all p<0.001). Patients with HFrEF and high burden of signs and symptoms more commonly had atrial fibrillation (AF) than those with low burden (32 vs 41%, p<0.001) while prevalence of AF was similar regardless of sign and symptom burden in HFpEF (32 vs 32%, p = 0.98). High burden of signs and symptoms was associated with greater risk of HHF or CV death in patients with HFrEF (HR 1.47; 95% CI, 1.35-1.61) than in those with HFpEF (HR 1.28; 95% CI, 1.13-1.44; p interaction = 0.03) (Figure). Conclusion: Patients with HFpEF have slightly higher burden of HF signs and symptoms than those with HFrEF. High burden of HF signs and symptoms identifies patients at high risk foradverse CV events, and may have greater prognostic importance in patients with HFrEF than HFpEF.