Presentation, Precipitants and Outcomes of Heart Failure and Preserved Ejection Fraction

Abstract

Background: Although heart failure with preserved ejection fraction (HFpEF) is increasingly important, it has not been as well characterised as has heart failure with reduced ejection fraction (HFrEF). The aim of this study was to compare the precipitants, presenting symptoms, and outcomes of HFpEF versus HFrEF. We also investigated the long-term outcomes in response to medical therapy. Methods: We classified 5236 patients enrolled in the Management of Cardiac Failure (MACARF) program in Northern Sydney, into HFpEF (n = 1956, 37.3%) and HFrEF (n = 3280, 62.6%) patients using a cut-off left ventricular ejection fraction of 50%. Cox proportional hazards models were used for analysis of discharge medications. Results: Compared to HFrEF, the precipitant of hospitalisation for patients with HFpEF was more commonly infection (31.3% vs. 26.3%), and less likely to be ischaemia (18.7% vs. 23.3%). Although the predominant presenting symptom for all patients was dyspnoea, HFpEF patients were more likely to present with peripheral oedema (52.6% vs. 43.4%), whilst HFrEF patients were more likely to present with paroxysmal nocturnal dyspnoea, fatigue, weight gain, nausea and angina. Mortality rates at 30-days and 1-year were similar however HFpEF patients had higher 1-year readmission rates (45.4% vs. 40.7%) due to increased non-HF readmissions (34.7% vs. 29.8%). Adjusted hazard ratios showed improved survival for HFpEF patients discharged with beta blockers (HR 0.74; 95% CI: 0.60-0.88) and statins (HR 0.68; 95% CI: 0.53-0.88). Conclusion: Our study provides insight into differences between heart failure patients with preserved and reduced ejection fraction, and provides clues for prevention of hospitalisation and improved outcome.