Patients with heart failure with mid-range ejection fraction: role of comorbidity

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Patients with mid-range ejection fraction (HFmrEF) are still a ‘grey area’ for clinical practice. The aim of this study was to investigate comorbidity, quality of life and psychological status of patients with HFmrEF. Materials and methods. One hundred and four patients patients with CHF (69 males and 35 females, mean age was 61.7 ± 9.6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, 2016. Age-adjusted Charlson Comorbidity Index (ACCI) was calculated. Comorbidity was regarded as high at index ≥ 6 scores. Psychological state, cognitive functions, quality of life and adherence to treatment were estimated using MMPI, MMSE, SF-36 Health Status Survey, Four-Item Morisky Green Levine Medication Adherence Scale. Follow-up period was 12 months. Results. Forty-six (44.2%) patients had HFmrEF, 58 (55.8%) - heart failure with preserved ejection fraction (HFpEF). The Charlson comorbidity index did not differ depending on left ventricular (LV) ejection fraction (EF) (5.4 ± 2.1 points for patients with HFmrEF and 4.8 ± 2.1 points for patients with HFpEF, resp., p = 0.1). LV mass index (LVMI) was more in patients HFmrEF with than in patients with HFpEF: 213.4 ± 57.7 and 176.6 ± 44.3 g/m2, resp., p = 0.009. Patients with HFmrEF had a higher functional class HF (the 6 Minute walk test - 307.4 ± 92.4 m for patients with HFmrEF and 339.0 ± 78.7 m for patients with HFpEF, p = 0.02). Twelve (11.5%) died during the 12-month follow-up. Mortality depending on LVEF did not differ. Patients with HFmrEF had lower indicators of quality of life on the physical scale: physical functioning (36.3 ± 14.2 and 48.1 ± 13.3 points resp. p = 0.006) and on the psychological health scale (33.4 ± 5.3 and 35.8 ± 6.7 points, resp.,p = 0.03) compared with patients with HFpEF. The full adherence to treatment for both groups of patients was low (30%) and did not differ. Patients with HFmrEF had a higher profile of depressive-hypochondriacal conditions, primitive and maladaptive psychological defense mechanisms compared with patients with HFpEF. Conclusion. Patients with HFmrEF are characterized by more severe clinical course, lower quality of life and high frequency of depressive-hypochondriacal conditions, primitive and maladaptive psychological defense mechanisms in comparison with patients with HFpEF, which should be taken into account in the development of interdisciplinary approach to this category of patients.