In-hospital mortality and prognostic factors in patients admitted for new-onset heart failure with preserved or reduced ejection fraction: a prospective observational study

Abstract

Heart failure (HF) is associated with high morbidity and mortality. A significant component of HF-related adverse outcome occurs during hospitalization. Objective. - To assess features and in-hospital outcomes of patients hospitalized for a first episode of HF. We prospectively recruited 799 consecutive patients hospitalized for a first episode of HF during 2000 in the Somme department (France). We evaluated in-hospital mortality in this cohort, identified factors predictive for hospital death, and compared the mortality in patients with preserved or reduced ejection fraction (EF). The mean age of the study population was 75+/-12 years. EF, assessed in 662 patients (83%), was preserved (> or = 50%) in 56% of cases. During hospitalization, 64 deaths (8%) were recorded. The major causes of in-hospital death were acute pulmonary oedema (50%) and cardiogenic shock (22%). Coronary artery disease, low systolic blood pressure on admission, increased heart rate on admission, renal failure, reduced EF (<50%) and older age were identified as independent predictors of in-hospital mortality. Patients with preserved EF were older and comprised a greater proportion of women. In-hospital mortality of the reduced EF group was higher than that of the preserved EF group (8.2% versus 2.7%, p=0.002). On multivariable analysis, reduced EF was independently associated with in-hospital death (odds ratio 2.32; 95% confidence interval 1.06-5.11; p=0.03). In propensity-matched patients, in-hospital mortality was higher in the reduced EF group (7.6% versus 2.2% p=0.02). The in-hospital outcome of patients admitted for new-onset HF is poor. Patients with preserved EF are older but have lower in-hospital mortality.