Electronic-based Characterization And Outcomes Of Heart Failure With Preserved Ejection Fraction

Abstract

Background The performance of electronic health record (EHR) screening for heart failure with preserved ejection fraction (HFpEF) is variable. We sought to characterize HFpEF populations identified by different EHR screening strategies and associated outcomes. Methods and Results We retrospectively analyzed 9,263 consecutive patients from an academic referral center who underwent both echocardiography and right heart catheterization (RHC) within six months of each other between January 2008 - December 2018. Three EHR-based screening strategies identified patients with HFpEF using ICD-9/10 codes (n=5,274), H2FpEF score ≥6 and ejection fraction (EF) ≥50% (n=1,730), and RHC criteria of pulmonary capillary wedge ≥15 mmHg and EF ≥50% (n=2,224). Primary outcomes of interest were incident heart failure hospitalizations (HFH) and all-cause mortality over 10 years. For each HFpEF definition, cumulative mortality event rates were estimated as a function of follow-up time with the use of the Kaplan-Meier method and incident HFH rates by a nonparametric cumulative incidence function estimator accounting for all-cause mortality as a competing risk. Overall population who underwent RHC were 61.5 (±14.7) years old, 44% female, and 73% Caucasian/White. Of 6,353 patients who met any HFpEF criteria, 33% satisfied ≥2 HFpEF screening methods. Female sex was more common among RHC-based HFpEF (55%) compared to other methods (47% for H2FpEF and 43% for ICD). Atrial fibrillation was substantial higher among HFpEF identified by the H2FPEF score (97%) compared to other methods (49% for ICD and 47% for RHC). Cumulative incidence rates for HFH and all-cause mortality are shown in Figure. Conclusions Differences in EHR-based HFpEF definitions identifies populations with varying baseline characteristics and outcomes. These data have implications for EHR screening for HFpEF. The performance of electronic health record (EHR) screening for heart failure with preserved ejection fraction (HFpEF) is variable. We sought to characterize HFpEF populations identified by different EHR screening strategies and associated outcomes. We retrospectively analyzed 9,263 consecutive patients from an academic referral center who underwent both echocardiography and right heart catheterization (RHC) within six months of each other between January 2008 - December 2018. Three EHR-based screening strategies identified patients with HFpEF using ICD-9/10 codes (n=5,274), H2FpEF score ≥6 and ejection fraction (EF) ≥50% (n=1,730), and RHC criteria of pulmonary capillary wedge ≥15 mmHg and EF ≥50% (n=2,224). Primary outcomes of interest were incident heart failure hospitalizations (HFH) and all-cause mortality over 10 years. For each HFpEF definition, cumulative mortality event rates were estimated as a function of follow-up time with the use of the Kaplan-Meier method and incident HFH rates by a nonparametric cumulative incidence function estimator accounting for all-cause mortality as a competing risk. Overall population who underwent RHC were 61.5 (±14.7) years old, 44% female, and 73% Caucasian/White. Of 6,353 patients who met any HFpEF criteria, 33% satisfied ≥2 HFpEF screening methods. Female sex was more common among RHC-based HFpEF (55%) compared to other methods (47% for H2FpEF and 43% for ICD). Atrial fibrillation was substantial higher among HFpEF identified by the H2FPEF score (97%) compared to other methods (49% for ICD and 47% for RHC). Cumulative incidence rates for HFH and all-cause mortality are shown in Figure. Differences in EHR-based HFpEF definitions identifies populations with varying baseline characteristics and outcomes. These data have implications for EHR screening for HFpEF.