Patient profiles in heart failure with reduced ejection fraction: prevalence, characteristics, treatments and outcomes in a real-world heart failure population.

Abstract

The Heart Failure Association of the European Society of Cardiology has recently proposed to optimize guidelines-directed medical treatments according to patient's profiles. Aim of this analysis was to investigate prevalence/characteristics/treatments/outcomes for individual profiles. Patients with heart failure with reduced ejection fraction (HFrEF) enrolled in the Swedish Heart Failure Registry (SwedeHF) between 2013-2021 were considered. Among 108 profiles generated by combining different strata of renal function (by estimated glomerular filtration rate, eGFR), systolic blood pressure (sBP), heart rate, atrial fibrillation (AF) status and presence of hyperkalaemia, 93 were identified in our cohort. Event rates for a composite of cardiovascular (CV) mortality or first HF hospitalization were calculated for each profile. The 9 most frequent profiles accounting for 70.5% of the population had eGFR 30-60 or ≥60 mL/min/1.73m2 , sBP 90-140mmHg and no hyperkalaemia. Heart rate and AF were evenly distributed. The highest risk of CV mortality/first HF hospitalization was observed in those with concomitant eGFR 30-60 mL/min/1.73m2 and AF. We also identified 9 profiles with the highest event rates, representing only 5% of the study population, characterized by no hyperkalaemia, even distribution among the sBP strata, predominance of eGFR <30mL/min/1.73m2 and AF. The 3 profiles with eGFR 30-60mL/min/1.73m2 also showed sBP <90mmHg. In a real-world cohort most patients fit in a few easily identifiable profiles; the 9 profiles at highest risk of mortality/morbidity accounted for only 5% of the population. Our data might contribute to identifying profile-tailored approaches to guide drugs´ implementation and follow-ups. This article is protected by copyright. All rights reserved.