Heart Failure With Preserved Ejection Fraction Hospitalization Research Articles

Risk Factors and Outcomes Associated With Heart Failure With Preserved and Reduced Ejection Fraction in People With Chronic Kidney Disease.

Heart failure (HF) is associated with poor outcomes in people with chronic kidney disease, yet it is unknown whether outcomes differ by HF subtype. This study aimed to examine associations of incident HF with preserved ejection fraction (HFpEF) versus HF with reduced ejection fraction (HFrEF) with progression to end-stage kidney disease (ESKD) and mortality. We studied individuals with chronic kidney disease in the CRIC study (Chronic Renal Insufficiency Cohort) who were free of HF at cohort entry. Incident HF hospitalizations were adjudicated and classified into HFpEF (ejection fraction, ≥50%) or HFrEF (ejection fraction, <50%) based on echocardiograms performed during the hospitalization or at a research study visit. ESKD was defined as need for chronic dialysis or kidney transplant. Cox proportional hazards were used to evaluate the association of time-updated HF subtype with risk of ESKD and mortality, adjusting for demographics, comorbidities, and medication use. Among the 3557 study participants without HF at cohort entry, mean age was 57 years and mean estimated glomerular filtration rate was 45 mL/min per 1.73 m2. A total of 682 participants had incident HF. Incidence rates for HFpEF and HFrEF were 0.9 (95% CI, 0.8-1.0) and 0.7 (95% CI, 0.6-0.8) per 100 person-years, respectively (Pdifference=0.005). Associations of incident HF with progression to ESKD were not statistically different for HFpEF (hazard ratio, 2.06 [95% CI, 1.66-2.56]) and HFrEF (hazard ratio, 1.80 [95% CI, 1.36-2.38]; P=0.42). The associations with mortality were stronger for HFrEF (hazard ratio, 2.73 [95% CI, 2.24-3.33]) compared with HFpEF (hazard ratio, 1.99 [95% CI, 1.65-2.40]; P=0.0002). In a chronic kidney disease population, the rates of HFpEF hospitalizations were greater than that of HFrEF. Risk of ESKD was high but not statically different across HF subtypes. There was a stronger association of HFrEF with mortality. Prevention and treatment of both HFpEF and HFrEF should be central priorities to improve outcomes in chronic kidney disease.

Prognostic value of measurement of myocardial extracellular volume using dual-energy CT in heart failure with preserved ejection fraction

Diffuse myocardial fibrosis is associated with adverse outcomes in heart failure with preserved ejection fraction (HFpEF). Dual-energy CT (DECT) can noninvasively assess myocardial fibrosis by quantification of extracellular volume (ECV) fraction. This study evaluated the association between ECV measured by DECT and clinical outcomes in patients with HFpEF. 125 hospitalized HFpEF patients were enrolled in this retrospective cohort study. ECV was measured using DECT with late iodine enhancement. The composite endpoint was defined as HFpEF hospitalization and all-cause mortality during the follow-up. During the median follow-up of 10.4 months, 34 patients (27.20%) experienced the composite outcomes, including 5 deaths; and 29 HFpEF hospitalizations. The higher DECT-ECV group had higher rates of composite outcomes than the low ECV group (log-rank X2 = 6.818, P = 0.033). In multivariate Cox regression analysis, the ECV (HR 1.17, 95% CI 1.06–1.30, P = 0.001) and NT-pro BNP (HR 2.83, 95% CI 1.16–6.88, P = 0.022) were independent risk factors for the adverse outcomes. Myocardial ECV measured using DECT was an independent risk factor for adverse outcomes in patients with HFpEF.

Heart Failure Risk Among African-American Women With an ICAM1 Missense Variant

BackgroundA common genetic variant of ICAM1 among African-American individuals (rs5491; p.K56M) is associated with heart failure (HF) hospitalization, but whether this risk is specific to heart failure with preserved ejection fraction (HFpEF) remains unclear. Older women are at high risk for HFpEF, and the relationship between rs5491 and HFpEF across the age spectrum is unknown. ObjectivesThis study assessed risk of HF and its subtypes conferred by ICAM1 p.K56M (rs5491). MethodsAssociations of rs5491 with risk of HF and its subtypes were estimated among African American individuals in WHI (Women’s Health Initiative). The study evaluated whether the association between rs5491 and HF hospitalizations was modified by baseline age. Subsequently, African-American women in WHI and MESA (Multi-Ethnic Study of Atherosclerosis) were pooled and analyses were repeated. ResultsAmong 8,401 women in WHI, the minor allele frequency of rs5491 was 20.7%, and 731 HF hospitalizations occurred over 19.2 years. The rs5491 variant was not associated with HF or its subtypes across WHI. Interaction analyses suggested that age as a continuous variable modified the association of rs5491 with HFpEF hospitalization (interaction P = 0.04). Upon categorizing women into age decades, rs5491 conferred increased risk of HFpEF among women ≥70 years (HR per additional rs5491 allele: 1.82 [95% CI: 1.25-2.65]; P = 0.002) but was not associated with HFpEF risk among women <70 years. Pooling African-American women in WHI (n = 8,401) and MESA (n = 856) demonstrated that the effect modification by age on the association of rs5491 with HFpEF became more significant (interaction P = 0.009), with consistent HFpEF risk effect estimates among women ≥70 years. ConclusionsICAM1 p.K56M (rs5491) is associated with HFpEF among African-American women ≥70 years.

Diabetic microvascular complications predicts non-heart failure with reduced ejection fraction in type 2 diabetes.

The relationship between diabetic microvascular complications and the incidence of two types of heart failure-heart failure with reduced ejection fraction (HFrEF) (left ventricular ejection fraction [LVEF]<40%) and non-HFrEF (LVEF≥40%)-in patients without prior heart failure has not been clarified. We herein examined the association between diabetic microvascular complications and HFrEF or non-HFrEF in patients with type 2 diabetes mellitus (T2DM) without prior heart failure. In this retrospective cohort study, we assessed the relationship between the presence of diabetic microvascular complications or severity of diabetic retinopathy (no apparent, non-proliferative and proliferative retinopathy) and nephropathy (normoalbuminuria, microalbuminuria, and macroalbuminuria) at baseline, with the primary outcome of first heart failure hospitalization classified as HFrEF or non-HFrEF in patients with type 2 diabetes mellitus without prior heart failure. Among 568 patients (69.2% males, mean age 66.2±9.6years), 70 experienced heart failure hospitalization (HFrEF: 24 and non-HFrEF: 46). Non-HFrEF hospitalization but not HFrEF hospitalization was significantly associated with the presence of diabetic microvascular complications. The incidence of non-HFrEF hospitalization was significantly higher in the proliferative retinopathy group than that in the no apparent retinopathy group (adjusted hazard ratio [HR] 2.96, 95% confidence interval [CI]: 1.09-6.83, P=0.035) and in those with macroalbuminuria than in those with normoalbuminuria (adjusted HR 4.23, 95% CI: 2.24-7.85, P<0.001) even after adjustment for age and sex. When non-HFrEF was classified into heart failure with mildly reduced ejection fraction (HFmrEF) (40%≤LVEF<50%) and heart failure with preserved ejection fraction (HFpEF) (50%≤LVEF), HFmrEF and HFpEF hospitalizations were also found to be associated with the progression of retinopathy and nephropathy. In patients with T2DM without prior heart failure, non-HFrEF hospitalization was more closely associated with the progression of diabetic microangiopathy than HFrEF. The development of non-HFrEF may be mediated through a mechanism similar to that of microvascular complications in these patients.

Empagliflozin Preserves Skeletal Muscle Function in a HFpEF Rat Model.

Besides structural alterations in the myocardium, heart failure with preserved ejection fraction (HFpEF) is also associated with molecular and physiological alterations of the peripheral skeletal muscles (SKM) contributing to exercise intolerance often seen in HFpEF patients. Recently, the use of Sodium-Glucose-Transporter 2 inhibitors (SGLT2i) in clinical studies provided evidence for a significant reduction in the combined risk of cardiovascular death or hospitalization for HFpEF. The present study aimed to further elucidate the impact of Empagliflozin (Empa) on: (1) SKM function and metabolism and (2) mitochondrial function in an established HFpEF rat model. At the age of 24 weeks, obese ZSF1 rats were randomized either receiving standard care or Empa in the drinking water. ZSF1 lean animals served as healthy controls. After 8 weeks of treatment, echocardiography and SKM contractility were performed. Mitochondrial function was assessed in saponin skinned fibers and SKM tissue was snap frozen for molecular analyses. HFpEF was evident in the obese animals when compared to lean—increased E/é and preserved left ventricular ejection fraction. Empa treatment significantly improved E/é and resulted in improved SKM contractility with reduced intramuscular lipid content. Better mitochondrial function (mainly in complex IV) with only minor modulation of atrophy-related proteins was seen after Empa treatment. The results clearly documented a beneficial effect of Empa on SKM function in the present HFpEF model. These effects were accompanied by positive effects on mitochondrial function possibly modulating SKM function.

Mortality and readmission risk in relation to QRS duration among patients hospitalized for heart failure with preserved ejection fraction

BackgroundIn ambulatory patients with heart failure (HF) with preserved ejection fraction (HFpEF), QRS prolongation (QRS > 120 msec) and left bundle branch block (LBBB) each carry an increased risk of cardiovascular mortality and/or HF hospitalization. Less is known about implications of conduction abnormalities following an acute HF hospitalization for HFpEF. Methods and resultsA retrospective cohort of 1454 patients discharged from after a HF hospitalization between 2015 and 2019 with ejection fraction (EF) ≥ 45% were identified (age 75.1 ± 10.8 years, EF 58.5% ± 10.2%). All patients' electrocardiograms were classified by QRS duration (prolonged – 545 [37.5%] vs. normal [QRS ≤ 120 msec] 909 [62.5%]). QRS prolongation was comprised of: LBBB (4.2%), right bundle branch block (RBBB, 18.3%), intraventricular conduction delay (9.7%), and ventricularly paced (9.7%). Over 4.09 ± 1.00 years, 769 (52.9%) patients died. Survival was similar between normal and prolonged QRS cohorts with an age and sex adjusted hazard ratio of 1.01 (95%CI: 0.87–1.17, p = 0.16). Recurrent HF hospitalization occurred in 91 (16.7%) with QRS prolongation vs. 90 (9.9%) without (odds ratio: 1.82 [95%CI: 1.33–2.50, p < 0.001]). RBBB carried 2.26 higher odds of recurrent HF hospitalization (95%CI: 1.56–3.28). ConclusionsFollowing a HF hospitalization, QRS prolongation increased the odds of re-admission for HF in patients with HFpEF without differences in overall mortality.

Performance of non-invasive myocardial work to predict the first hospitalization for de novo heart failure with preserved ejection fraction (HFpEF)

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Dr. Paolisso, Dr. Esposito, Dr. Fabbricatore are supported by a research grant from the CardioPaTh PhD Program of University of Naples Federico II Background Non-invasive myocardial work (MW) is a validated index of left ventricular (LV) systolic performance, incorporating afterload and myocardial metabolism. The role of MW in predicting the first hospitalization for de novo heart failure with preserved ejection fraction (HFpEF) is still unknown. Purpose To investigate the diagnostic performance of MW to predict the first de novo HFpEF hospitalization in ambulatory individuals with preserved LVEF. Methods Twenty-nine patients with trans-thoracic echocardiography performed at least 6 months before the first HFpEF hospitalization were compared with 29 matched controls. MW was derived as the area of pressure-strain loop using speckle-tracking and brachial artery blood pressure. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were collected. First HFpEF hospitalization and its combination with cardiovascular death (MACE) and all-cause of death (MAE) were assessed. Results At baseline, future HFpEF patients showed lower GWI, GCW, GWE and higher GWW than controls (all p &amp;lt; 0.05). At admission versus baseline, GWE significantly decreased, and GWW increased in the HFpEF group (p &amp;lt; 0.05), whereas no significant difference was observed in the controls over time. GWW, with a cut-off of 170 mmHg%, showed the largest AUC to predict first HFpEF hospitalization (AUC = 0.80, 95% CI 0.69–0.91, p &amp;lt; 0.001), MACE (AUC = 0.80, 95% CI 0.66–0.90, p &amp;lt; 0.001) and MAE (AUC = 0.79, 95% CI 0.62–0.88, p = 0.001). GWW &amp;gt; 170 mmHg% was associated with a 4-fold increase of MACE (HR = 4.5, 95% CI 1.59–13.12, p = 0.005) and a 3-fold higher risk of MAE (HR = 2.9, 95% CI 1.24–6.6, p = 0.014). Conclusions In ambulatory patients with preserved LVEF and risk factors, GWW showed high accuracy to predict the first HFpEF hospitalization and its combination with mortality. The GWW routine assessment may be clinically helpful in patients with dyspnea. Abstract Figure 1: Serial changes of LARs, LV GLS Abstract Figure 2:Kaplan–Meier survival curves fo

Preeclampsia Predicts Risk of Hospitalization for Heart Failure With Preserved Ejection Fraction

BackgroundPreeclampsia is associated with increased risk of future heart failure (HF), but the relationship between preeclampsia and HF subtypes are not well-established. ObjectivesThe objective of this analysis was to identify the risk of HF with preserved ejection fraction (HFpEF) following a delivery complicated by preeclampsia/eclampsia. MethodsA retrospective cohort study using the New York and Florida state Healthcare Cost and Utilization Project State Inpatient Databases identified delivery hospitalizations between 2006 and 2014 for women with and without preeclampsia/eclampsia. The authors identified women admitted for HF after discharge from index delivery hospitalization until September 30, 2015, using International Classification of Diseases-9th Revision-Clinical Modification diagnosis codes. Patients were followed from discharge to the first instance of primary outcome (HFpEF hospitalization), death, or end of study period. Secondary outcomes included hospitalization for any HF and HF with reduced ejection fraction, separately. The association between preeclampsia/eclampsia and HFpEF was analyzed using Cox proportional hazards models. ResultsThere were 2,532,515 women included in the study: 2,404,486 without and 128,029 with preeclampsia/eclampsia. HFpEF hospitalization was significantly more likely among women with preeclampsia/eclampsia, after adjusting for baseline hypertension and other covariates (aHR: 2.09; 95% CI: 1.80-2.44). Median time to onset of HFpEF was 32.2 months (interquartile range: 0.3-65.0 months), and median age at HFpEF onset was 34.0 years (interquartile range: 29.0-39.0 years). Both traditional (hypertension, diabetes mellitus) and sociodemographic (Black race, rurality, low income) risk factors were also associated with HFpEF and secondary outcomes. ConclusionsPreeclampsia/eclampsia is an independent risk factor for future hospitalizations for HFpEF.

Performance of non-invasive myocardial work to predict the first hospitalization for de novo heart failure with preserved ejection fraction.

AimsNon‐invasive myocardial work (MW) is a validated index of left ventricular (LV) systolic performance, incorporating afterload and myocardial metabolism. The role of MW in predicting the first hospitalization for de novo heart failure with preserved ejection fraction (HFpEF) is still unknown. We aim to investigate the diagnostic performance of MW to predict the first de novo HFpEF hospitalization in ambulatory individuals with preserved LV ejection fraction.Methods and resultsTwenty‐nine patients with transthoracic echocardiography performed at least 6 months before the first HFpEF hospitalization were compared with 29 matched controls. MW was derived as the area of pressure–strain loop using speckle‐tracking and brachial artery blood pressure. Global work index, global constructive work, global wasted work (GWW), and global work efficiency (GWE) were collected. First HFpEF hospitalization and its combination with cardiovascular death [major adverse cardiovascular events (MACE)] and all‐cause of death [major adverse events (MAE)] were assessed. At baseline, future HFpEF patients showed lower global work index, global constructive work, GWE, and higher GWW than controls (all P < 0.05). At admission vs. baseline, GWE significantly decreased, and GWW increased in the HFpEF group (P < 0.05), whereas no significant difference was observed in the controls over time. GWW, with a cut‐off of 170 mmHg%, showed the largest area under the curve (AUC) to predict first HFpEF hospitalization [AUC = 0.80, 95% confidence interval (CI) 0.69–0.91, P < 0.001], MACE (AUC = 0.80, 95% CI 0.66–0.90, P < 0.001), and MAE (AUC = 0.79, 95% CI 0.62–0.88, P = 0.001). GWW > 170 mmHg% was associated with a 4‐fold increase of MACE (HR = 4.5, 95% CI 1.59–13.12, P = 0.005) and a 3‐fold higher risk of MAE (HR = 2.9, 95% CI 1.24–6.6, P = 0.014).ConclusionsIn ambulatory patients with preserved LV ejection fraction and risk factors, GWW showed high accuracy to predict the first HFpEF hospitalization and its combination with mortality. The GWW routine assessment may be clinically helpful in patients with dyspnoea.

Abstract 14203: Implications of Atrial Fibrillation on Clinical Outcomes of Patients With Heart Failure With Preserved Ejection Fraction

Background: Atrial fibrillation and heart failure with preserved ejection fraction(HFpEF) are closely interrelated, and atrial fibrillation confer poor prognosis in HFpEF patients. Objective: We sought to study outcomes and implications of atrial fibrillation among patients hospitalized with HFpEF. Methods: Patients with a principal discharge diagnosis of HFpEF between 2016 and 2018 were identified in the National Readmissions Database. Among those, patients with and without a secondary diagnosis of atrial fibrillation were categorized. HFpEF hospitalizations with atrial fibrillation were matched 1:1 fashion to HFpEF without atrial fibrillation using age, sex, and Charlson comorbidity index. Results: Of the 195,110 HFpEF hospitalizations, 66,584 had HFpEF with a secondary diagnosis of atrial fibrillation. Propensity score-matched comparison between HFpEF with and without atrial fibrillation showed higher in-patient mortality (3.18% vs. 2.58%, P=0.00), Cardiogenic shock (0.62% vs. 0.39%, P=0.00) and bleeding (2.09% vs. 1.08%, P=0.00) as compared with HFpEF without atrial fibrillation. Total charges were higher in HFpEF with atrial fibrillation compared to patients without atrial fibrillation ($ 46018.97 vs. $ 43692.16). The 30 days all-cause readmission rate among patients admitted with HFpEF and survived index hospitalization was 20.14% (95% CI 19.96 - 20.31%). Conclusion: In patients with HFpEF presence of atrial fibrillation was associated with higher inpatient mortality. Figure 1: Patient selection flow diagram Table 1: Outcomes of HFpEF Patients with and without Atrial Fibrillation in Propensity-Matched Groups.

Worsening Renal Function during Index Hospitalization Does Not Predict Prognosis in Heart Failure with Preserved Ejection Fraction Patients

Introduction: Worsening renal function (WRF) predicts poor prognosis in patients with left ventricular systolic dysfunction. The effect of WRF in heart failure with preserved ejection fraction (HFpEF) is unclear. Objective: The objective of this study was to determine whether WRF during index hospitalization for HFpEF is associated with increased death or readmission for heart failure. Methods: National Veterans Affairs electronic medical data recorded between January 1, 2002, and December 31, 2014, were screened to identify index hospitalizations for HFpEF using an iterative algorithm. Patients were divided into 3 groups based on changes in serum Cr (sCr) during this admission. WRF was defined as a rise in sCr ≥0.3 mg/dL. Group 1 had no evidence of WRF, group 2 had transient WRF, and group 3 had persistent WRF at the time of discharge. Results: A total of 10,902 patients with index hospitalizations for HFpEF were identified (mean age 72, 97% male). Twenty-nine percent had WRF during this hospital admission, with 48% showing recovery of sCr and 52% with no recovery at discharge. The mortality rate over a mean follow-up duration of 3.26 years was 72%. Compared to group 1, groups 2 and 3 showed no significant difference in risk of death from any cause (hazard ratio [HR] = 0.95 [95% confidence interval [CI]: 0.87, 1.03] and 1.02 [95% CI: 0.93, 1.11], respectively), days hospitalized for any cause (incidence density ratio [IDR] = 1.01 [95% CI: 0.92, 1.11] and 1.01 [95% CI: 0.93, 1.11], respectively), or days hospitalized for heart failure (IDR = 0.94 [95% CI: 0.80, 1.10] and 0.94 [95% CI: 0.81, 1.09], respectively) in analyses adjusted for covariates affecting renal function and outcomes. Conclusions: While there is a high incidence of WRF during index hospitalizations for HFpEF, WRF is not associated with an increased risk of death or hospitalization. This suggests that WRF alone should not influence decisions regarding heart failure management.

A Practical Risk Score for Prediction of Early Readmission after a First Episode of Acute Heart Failure with Preserved Ejection Fraction.

Background: The first admission for acute heart failure with preserved ejection fraction (HFpEF) drastically influences the short-term prognosis. Baseline characteristics may predict repeat hospitalization or death in these patients. Methods: A 103 patient-cohort, admitted for the first acute HFpEF episode, was monitored for six months. Baseline characteristics were recorded and their relation to the primary outcome of heart failure readmission (HFR) and secondary outcome of all-cause mortality was assessed. Results: We identified six independent determinants for HFR: estimated glomerular filtration rate (eGFR) (p = 0.07), hemoglobin (p = 0.04), left ventricle end-diastolic diameter (LVEDD) (p = 0.07), E/e’ ratio (p = 0.004), left ventricle outflow tract velocity-time integral (LVOT VTI) (p = 0.045), and diabetes mellitus (p = 0.06). Three of the variables were used to generate a risk score for HFR: LVEDD, E/e’, LVOT VTI -DEI Score = − 28.763 + 4.558 × log (LVEDD (mm)) + 1.961 × log (E/e’ ratio) + 1.759 × log (LVOT VTI (cm)). Our model predicts a relative amount of 20.50% of HFR during the first 6 months after the first acute hospitalization within the general population with HFpEF with a DEI Score over −0.747. Conclusions: We have identified three echocardiographic parameters (LVEDD, E/e’, and LVOT VTI) that predict HFR following an initial acute HFpEF hospitalization. The prognostic DEI score demonstrated good accuracy.

Pregnancy Associated Heart Failure With Preserved Ejection Fraction: Risk Factors and Maternal Morbidity

BackgroundCardiovascular conditions are leading contributors to increasing maternal morbidity and mortality. Heart failure with preserved ejection fraction (HFpEF) results in the majority of HF admissions in women, yet its impact in pregnancy is unknown. We examined the prevalence rates, risk factors and adverse pregnancy outcomes in women with HFpEF during pregnancy-related hospitalizations in the United States. Methods and ResultsWe conducted a cross-sectional analysis of pregnancy-related hospitalizations from 2002 through 2014 using the National Inpatient Sample. HFpEF cases were identified using the 428.3 International Classification of Diseases, 9th edition, Clinical Modification code. Weighting variables were used to provide national estimates, unconditional survey logistic regression to generate odds ratios and 95% confidence intervals (CI) representing adjusted associations with adverse pregnancy outcomes and Joinpoint regression to estimate temporal trends. Among 58,732,977 hospitalizations, there were 3840 HFpEF cases, an overall rate of 7 cases per 100,000 pregnancy-related hospitalizations; 56% occurred postpartum, 27% during delivery, and 17% antepartum. The temporal trend for hospitalization increased throughout the timeframe by 19.4% (95% CI 13.9–25.1). HFpEF hospitalizations were more common for Black, older, or poor women. Risk factors included hypertension (chronic hypertension and hypertensive disorders of pregnancy), anemia, obesity, diabetes, renal disease and coronary atherosclerosis; all known risk factors for HFpEF. Women with HFpEF were 2.61–6.47 times more likely to experience adverse pregnancy outcomes. ConclusionsThe pregnancy-related HFpEF hospitalization prevalence has increased and is associated with adverse pregnancy outcomes. Risk factors resemble those outside pregnancy, emphasizing the need for screening and monitoring women with risk factors during pregnancy for HFpEF.

Abstract 17235: Comparision of Outcomes in Patients Undergoing Catheter versus Surgical Ablation for Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction

Introduction: There is a lack of research comparing outcomes of Surgical Ablation (SA) and Catheter Ablation (CA) among Atrial Fibrillation(AF) patients with heart failure with Preserved Ejection Fraction (HFpEF) and . Hypothesis: The main objective is to compare short-term clinical outcomes of SA and CA in AF patients with HFpEF. Methods: We used the national inpatient sample to identify patients over 18 years with HFpEF hospitalization and AF, and undergoing SA and CA from 2016 - 2017. The clinical outcomes of SA versus CA in AF stratified as non-paroxysmal and paroxysmal were analyzed. Results: 1,530 HFpEF hospitalizations with AF who underwent SA and 1,045 HFpEF hospitalizations with AF who underwent CA were included in the analysis. Patients undergoing CA had higher baseline comorbidity. The in-hospital mortality between HFpEF with AF undergoing SA as compared to CA was similar (1.9% versus 1.4%, adjusted P-value 0.04). Patients undergoing SA had a significantly longer length of hospital stay, a higher percentage of post-procedural, and cardiac complications. In HFpEF patients with non-paroxysmal AF, SA as opposed to CA was associated with a higher percentage of in-hospital mortality (2.7% versus 0%, adjusted P-value=0.23), a longer length of stay, a higher cost of treatment, and a higher percentage of cardiac complications. Conclusions: In conclusion, CA is associated with lower in-hospital outcomes as compared to SA among AF with HFpEF patients. Further research with freedom from AF is needed between this group with long-term out c omes.

Abstract 14883: The Role of Obstructive Sleep Apnea in Hospitalization in Heart Failure With Preserved Ejection Fraction and Diabetes Mellitus

Introduction: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous disease with diverse etiologies. Obstructive sleep apnea (OSA) is known to increase the risk of diastolic dysfunction and heart failure. OSA also increases the risk and severity of type 2 diabetes (DM2) independent of age and obesity. However, its role in patients with HFpEF and concomitant DM2 is unclear. Hypothesis: Our aim was to study the role of OSA in hospitalizations in patients with HFpEF and concomitant DM2. Methods: We did a retrospective chart analysis of 142 patients age (72 ± 11, 54.9% women) with HFpEF and known DM2 for five years after the initial diagnosis of HFpEF. Presence of OSA at the time of initial HFpEF diagnosis was noted based on the results of a documented sleep study. A multivariable cox-proportional hazard model was used to assess whether the presence of OSA had any significant impact on the risk of future HFpEF hospitalization. Kaplan-Meier analysis was used to calculate if OSA predicted time to future HFpEF hospitalization. Results: After a five year follow up, 63 (44.3%) participants developed HFpEF exacerbation. Patients were dichotomized based on presence (n=40, 28.1%) or absence (n=102, 71.8%) of OSA. In a multivariable model adjusted for baseline demographics, risk factors and medications, presence of OSA did not predict risk for a future HFpEF hospitalization (p=0.57, Table). Additionally, on Kaplan-Meier analysis, presence of OSA was not a significant predictor for HFpEF hospitalization (p=0.77, Figure). Conclusion: In patients with HFpEF and concomitant DM2, presence of OSA was not a predictor for future heart failure hospitalizations.

Outcomes of Septuagenarian and Octogenarian Females Hospitalized For Heart Failure with Preserved Ejection Fraction

Introduction Heart Failure with Preserved Ejection Fraction (HFpEF) is generally considered a disease of the elderly. Hospitalizations for HFpEF in the United States are rising, especially among women. It is largely unknown if there are any differences in-hospital outcomes between two elderly age groups of women admitted for acute HFpEF. Aim -To evaluate inpatient differences in outcomes between septuagenarian and octogenarian females admitted for acute HFpEF. Methods The United States Nationwide Inpatient Sample database was queried for hospitalizations of females aged 70 years and above with a primary diagnosis of HFpEF in 2016. Primary outcomes of interest include mortality, length of stay (LOS), and charges. A 1:1 propensity score matching (PSM) was performed to match octogenarians with septuagenarians based on race, region, and selected disease conditions. Outcomes were compared among matched cohorts using multivariable regression models. Results A total of 19,309 HFpEF hospitalizations were identified: 10,895 female patients were octogenarians, and 8,414 were septuagenarians. After PSM, 7,213 patients were matched in each group. Compared to septuagenarians, octogenarians were associated with increased odds of inpatient mortality (OR, 1.25 [1.02-1.54], P=0.0327), and an average of $4,973 less total hospital charges ($3271-$6675, P Conclusion Octogenarian hospitalizations compared to septuagenarian hospitalizations in women for HFpEF was associated with greater risk of in-hospital deaths, lower hospital charges, and decreased utilization of mechanical ventilation.

Characterization of the Progression From Ambulatory to Hospitalized Heart Failure With Preserved Ejection Fraction

Heart failure (HF) with preserved ejection fraction (HFpEF) is a heterogeneous syndrome. Some patients develop elevated filling pressures exclusively during exercise and never require hospitalization, whereas others periodically develop congestion that requires inpatient treatment. The features differentiating these cohorts are unclear. We performed a secondary analysis of 7 National Institutes of Health-sponsored multicenter trials of HFpEF (EF ≥ 50%, N = 727). Patients were stratified by history of hospitalization because of HF, comparing patients never hospitalized (HFpEFNH) to those with a prior hospitalization (HFpEFPH). Currently hospitalized (HFpEFCH) patients were included to fill the spectrum. Clinical characteristics, cardiac structure, biomarkers, quality of life, functional capacity, activity levels, and outcomes were compared. As expected, HFpEFCH (n = 338) displayed the greatest severity of congestion, as assessed by N-terminal pro B-type natriuretic peptide levels, edema and orthopnea. As compared to HFpEFNH (n = 109), HFpEFPH (n = 280) displayed greater comorbidity burden, with more lung disease, renal dysfunction and anemia, along with lower activity levels (accelerometry), poorer exercise capacity (6-minute walk distance and peak exercise capacity), and more orthopnea. Patients with current or prior hospitalization displayed higher rates of future HF hospitalization, but quality of life was similarly impaired in all patients with HFpEF, regardless of hospitalization history. A greater burden of noncardiac organ dysfunction, sedentariness, functional impairment, and higher event rates distinguish patients with HFpEF and prior HF hospitalization from those never hospitalized. Despite lower event rates, quality of life is severely and similarly limited in patients with no history of hospitalization. These data suggest that the 2 clinical profiles of HFpEF may require different treatment strategies.

Regional adiposity and heart failure with preserved ejection fraction.

The role of obesity in the pathogenesis of heart failure (HF), and in particular HF with preserved ejection fraction (HFpEF), has drawn significant attention in recent years. The prevalence of both obesity and HFpEF has increased worldwide over the past decades and when present concomitantly suggests an obese-HFpEF phenotype. Anthropometrics, including body mass index, waist circumference, and waist-to-hip ratio, are associated with incident HFpEF. However, the cardiovascular effects of obesity may actually be driven by the distribution of fat, which can accumulate in the epicardial, visceral, and subcutaneous compartments. Regional fat can be quantified using non-invasive imaging techniques, including computed tomography, magnetic resonance imaging, and dual-energy X-ray absorptiometry. Regional variations in fat accumulation are associated with different HFpEF risk profiles, whereby higher epicardial and visceral fat have a much stronger association with HFpEF risk compared with elevated subcutaneous fat. Thus, regional adiposity may serve a pivotal role in the pathophysiology of HFpEF contributing to decreased cardiopulmonary fitness, impaired left ventricular compliance, upregulation of local and systemic inflammation, promotion of neurohormonal dysregulation, and increased intra-abdominal pressure and vascular congestion. Strategies to reduce total and regional adiposity have shown promise, including intensive exercise, dieting, and bariatric surgery programmes, but few studies have focused on HFpEF-related outcomes among obese. Further understanding the role these variable fat depots play in the progression of HFpEF and HFpEF-related hospitalizations may provide therapeutic targets in treating the obese-HFpEF phenotype.

Abstract 284: Length Of Stay In Index Hospitalization Of Decompensated Heart Failure With Preserved Ejection Fraction As A Factor For 30-day Readmission And 1-year Mortality

Introduction: Heart Failure is one of the leading causes of readmission in the United States. Heart Failure with preserved Ejection Fraction (HFpEF) accounts for a growing proportion of heart failure hospitalizations and accounts for approximately half of hospitalizations today. Unlike Heart Failure with reduced Ejection Fraction (HFrEF), there are no consensus-driven guidelines for the management of HFpEF. Methods: We collected demographic data, co-morbidities, laboratory and echocardiographic data on patients hospitalized with HFpEF throughout our health care system between August 2016 to August 2017. We assessed length of stay (LOS), whether the patient was re-admitted for any cause within 30 days and whether the patient died within 1 year of index hospitalization. We performed a Wilcoxon rank-sum test comparing patients who were both readmitted within 30 days for any reason and died within 1 year, against patients who were readmitted but were verified alive at one-year follow-up. Results: There were 366 patients hospitalized for HFpEF during the study period. Overall 30-day readmission rate was 24.3%, with a one-year mortality of 19.9%. One-year outcomes was verifiable for 359 patients. There were 27 patients who were readmitted within 30 days and died within one year of follow-up. Median LOS was significantly greater in patients during index hospitalization who died within 1 year of follow-up (Median LOS: 8 days, IQR 5-10 days), compared to patients who were readmitted within 30 days, but were alive at 1-year follow-up (Median LOS: 5 days, IQR: 3-8 days; p-value = 0.001). Conclusions: Among patients who were re-hospitalized within 30 days of an index hospitalization for HFpEF, LOS was significantly greater than patients who died within one year, compared to patients who remained alive at one-year follow-up. This may help identify a high-risk subset on index hospitalization and assist care transition teams and primary care physicians at follow-up in regarding discussions on goals of care and life sustaining treatments.

Abstract P481: Early Recognition of Heart Failure With Preserved Ejection Fraction (HFpEF): Ventricular Elastance as a Predictive Marker for Prevention and Treatment

Introduction: Heart failure with preserved ejection fraction (HFpEF) is the most common type of heart failure, carries a 50% mortality rate within 3 years of diagnosis with evidence to support early lifestyle behavioral modification as beneficial. Developing an understanding of markers that identify patients early, promotes early recognition and treatment. Objective: Use of a predictive marker, ventricular elastance, enables early identification of patients at-risk for HFpEF. Methods: Patients previously diagnosed with HFpEF were retrospectively identified. Through case-control and hierarchical linear regression modeling, biomarkers were identified that preceded the onset of HFpEF. Using Cox regression, we conducted a survival analysis to determine time to onset of HFpEF for each biomarker. Using repeated measures logistic regression, continuous variables were tested for interval progression toward disease onset, controlling for co-variates: age, race and sex. Results: Through retrospective analysis, 251 patients and 775 echocardiograms spanning nearly 20 years were identified. Through mixed linear regression, for the entire model, 7 biomarkers were identified as statistically significant and 1 biomarker, ventricular elastance (Ees), progressively increased leading to the time of HFpEF hospitalization. Conclusion: This study provides the methodology for testing a predictive marker, ventricular elastance, that enables early recognition of HFpEF.