Incidence and predictors of heart failure with improved ejection fraction category in a HFrEF patient population.

Abstract

The aim of the study was to assess the incidence and predictive factors of the development of heart failure with improved ejection fraction (HFimpEF) category during a 1year follow-up period in a heart failure with reduced ejection fraction (HFrEF) patient population managed in a heart failure outpatient clinic. The study evaluated data from patients enrolled in the Hungarian Heart Failure Registry (HHFR). The incidence and predictive factors of the development of the HFimpEF category after 1year follow-up were assessed in the group of patients who had HFrEF at baseline. We evaluated the incidence and predictors of the development of HFimpEF after a 1year follow-up in relation to time since diagnosis of HFrEF in patients diagnosed within 3months, between 3months and 1year, and beyond 1year. The predictive factors of the development of HFimpEF were analysed using univariate and multivariate logistic regression analysis. Of the 833 HFrEF patients enrolled in the HHFR, the development of HFimpEF was observed in 162 patients (19.5%) during 1year follow-up. In the whole patient population, independent predictors of the development of HFimpEF were female gender [odds ratio (OR): 1.73; 95% confidence interval (CI): 1.01-2.96; P<0.05], non-ischaemic aetiology (OR: 1.95; 95% CI: 1.15-3.30; P<0.05), and left ventricular end-diastolic diameter (LVEDD) <60mm (OR: 2.04; 95% CI: 1.18-3.51; P<0.05). The 1year incidence of HFimpEF decreased in relation to time since diagnosis of HFrEF. The incidence of HFimpEF was 27.1% in patients diagnosed within 3months, 18.4% in patients diagnosed between 3months and 1year, and 12.2% in patients diagnosed beyond 1year. Non-ischaemic aetiology (OR: 4.76; 95% CI: 1.83-12.4; P<0.01) and QRS width (OR: 0.81; 95% CI: 0.71-0.94; P<0.01) for patients diagnosed within 3months, LVEDD (OR: 0.54; 95% CI: 0.32-0.90; P<0.05) and left atrial diameter ≤45mm (OR: 5.44; 95% CI: 1.45-20.4; P<0.05) for patients diagnosed between 3months and 1year, and LVEDD<67mm (OR: 2.71; 95% CI: 1.07-6.88; P<0.05) for patients diagnosed beyond 1year were found to be independent predictive factors. In our study, in this HFrEF patient population managed in a heart failure outpatient clinic, the 1year incidence of HFimpEF was found to be ~20%. The 1year incidence of HFimpEF decreased in relation to time since diagnosis of HFrEF. The most important predictors of the development of HFimpEF were female sex, non-ischaemic aetiology, narrower QRS width, and smaller diameter of the left ventricle and left atrium.