Predictors of Ejection Fraction Improvement in Northland Heart Failure Patients

Abstract

Northland has a disproportionately high burden of cardiovascular disease, including heart failure (HF). Since 2019, there has been an increase in clinical focus on mid and far north HF patients, aiming to understand and improve HF care to this challenging and often comorbid patient group. Clinical data were prospectively collected, between October 2019 and March 2020, on 86 consecutive cardiology clinic patients with heart failure with reduced ejection fraction (HFrEF) in Kaitaia and Bay of Islands hospitals. Table 1 shows cohort demographics.Table 1Patient demographics.Number of patients86Mean age (yr)62% male85% Māori71% diabetic38 Open table in a new tab A total of 42% of patients had a >15% increase in ejection fraction (EF), as show in Figure 1. The strongest predictor of EF improvement was lack of ischaemic heart disease as a cause/contributor to HFrEF (Table 2). Figure 2 shows the uptake of Entresto (sacubitril/valsartan) and empagliflozin over time. The relationship with Entresto use largely reflects the fact that most patients NOT prescribed Entresto had an early significant improvement with other management.Table 2Predictors of EF improvement.EFDecline or no change≤15% increase>15% increasePatients (%)25 (29)25 (29)36 (42)Mean age (yr)616461% Māori727269% male888881Alcohol %402836Ischaemic %283217Non-adherence522Entresto %1008461Empagliflozin %202825Death310 Open table in a new tab Figure 2Use of newer guideline recommended HF therapy for the 86 patientsView Large Image Figure ViewerDownload Hi-res image Download (PPT) There has been a steady increase in used of guideline-recommended HF therapy in Northland rural hospital patients.