The clinical characteristics of acute heart failure patients with mid-range ejection fraction in Turkey: A subgroup analysis from journey HF-TR study

Abstract

Background: Heart failure (HF) is a clinical syndrome characterized with a wide spectrum of left ventricular (LV) structural and functional abnormalities. LV ejection fraction (EF) is considered important with respect to classifying HF patients because of differing patient demographics and prognosis; as well as the response to HF therapies. We aimed to investigate the clinical characteristics, demographics, in-hospital management and in-hospital outcome of HF patients with mid-range EF (HFmrEF) in comparison with those with HF patients with reduced EF (HFrEF) or HF patients with preserved EF (HFpEF) in a large acute HF (AHF) cohort. Materials-Methods and Results: The Journey HF-TR study is a multicenter, and observational registry. One thousand six hundred and six patients who were diagnosed with AHF were enrolled in this study. The mean age was 67.8 ± 13.0 years and 57.2% of the study population was male. Patients were classified as HFrEF (n = 1028, 64%), HFmrEF (n = 305, 19%), and HFpEF (n = 273, 17%) according to LVEF. HFmrEF patients were elder than HFrEF patients but younger than HFpEF patients and the female proportion was the highest in HFpEF group followed by HFmrEF and HFrEF groups (P < 0.001 and P = 0.03, respectively). The prevalence of coronary artery disease was 56.7% in HFmrEF patients. It was lower than HFrEF patients (65.2%) and higher than HFpEF patients (41.4%) (P < 0.001). The prescription of evidence-based HF drugs (Renin-Angiotensin-System blocker, beta-blocker, mineralocorticoid receptor antagonist) was similar in HFrEF and HFmrEF patients and higher than HFpEF patients. The in-hospital mortality rate was the lowest in patients with HFmrEF (1.8%, 7.3%, and 7.5%, respectively for HFmrEF, HFrEF, and HFpEF patients) (P < 0.001). Conclusion: Patients with HFmrEF has unique clinical, echocardiographic, hemodynamic, and biomarker features compared with HFrEF and HFpEF. However, patients with HFmrEF seem to be more similar to HFrEF, in terms of etiology and use of guideline recommended medical therapy.