Abstract 335: Practice Pattern Differences in the Early Treatment of Hospitalized Heart Failure Patients: Preserved Left Ventricular Ejection Fraction vs. Reduced Ejection Fraction

Abstract

Introduction: Approximately half of patients hospitalized with acute heart failure (AHF) have a preserved ejection fraction (HFpEF), for which there are few known treatments that improve clinical outcomes. We sought to examine initial clinical management in a large national cohort of patients with HFpEF compared to those with heart failure reduced ejection fraction (HFrEF). Methods: We identified patients aged ≥18 years admitted with AHF between January 2009 and June 2012 to hospitals that participate in the PREMIER, Inc. data warehouse. Patients with ICD-9-CM diagnosis codes consistent with HFpEF (428.30-428.33) and HFrEF (428.20-428.23) were included. Early treatments were defined as treatments on hospital day 0, 1 or 2. Results: We identified 52,913 patients with HFpEF and 65,502 patients with HFrEF at 427 hospitals (Table 1). HFpEF patients were more likely to be older, female with greater burden of comorbid disease. Diuretic use was similar, but patients with HFpEF were less likely to receive beta-blockers (68.8% vs. 76.6%, p-value < 0.0001), ACE-inhibitors (37.6% vs. 48.0%, p-value < 0.0001), vasodilators (7.4% vs. 8.1%, p-value < 0.0001), inotropes (2.1% vs. 7.0%, p-value < 0.0001) and were more likely to receive early non-invasive positive pressure ventilation (17.5% vs. 12.3% p-value < 0.0001) and early invasive mechanical ventilation (7.6% vs. 6.5% p-value < 0.0001). Covariate adjusted mean length of stay and in-hospital mortality were higher for HFrEF patients. Conclusions: In a large national cohort of patients hospitalized with AHF, there were several differences in the demographics, early treatment strategies and outcomes for HFpEF patients compared with HFrEF patients. Further work is needed to identify variation in the use of these treatments across hospitals and association with outcomes.