Heart failure with preserved ejection fraction has a better long-term prognosis than heart failure with reduced ejection fraction in old patients in a 5-year follow-up retrospective study. (1st April 2017)

• Record Type: Journal Article
• Authors: Kontogeorgos, Silvana; Thunström, Erik; Johansson, Magnus C.; Fu, Michael
• Is Part Of: International journal of cardiology. Volume 232(2017)
• Page Start: 86
• Page End: 92
• Publication Date: 2017-04-01
• Subjects: ACEi/ARBs angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers -- ACEi angiotensin converting enzyme inhibitors -- ARB angiotensin receptor blockers -- ASE American Society of Echocardiography -- BB beta-blockers -- BH4 tetrahydrobiopterin -- BSA body surface area -- e-GFR estimated glomerular filtration rate -- ESC European Society of Cardiology -- Hb haemoglobin -- HF heart failure -- HFpEF heart failure with preserved ejection fraction -- HFrEF heart failure with reduced ejection fraction -- LAVI left atrium volume index -- LBBB left bundle branch block -- LVEF left ventricular ejection fraction -- LVMI left ventricular mass index -- NT–proBNP N-terminal proB-type natriuretic peptide -- PCI percutaneous coronary intervention -- RWT relative wall thickness; Mortality -- HFpEF -- HFrEF; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.01.048
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The issue of whether prognosis is similar between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) remains unresolved. Because of the problem of inconsistency in the diagnostic criteria and because there is currently no lifesaving therapy available for HFpEF, it seems to be the right time to study the outcome of a clearly defined HFpEF compared with HFrEF in contemporary heart failure (HF) therapy. This study investigates 5-year-mortality and its prognostic factors in old patients with HFpEF compared with those with HFrEF. Methods: This is a retrospective study. Patients hospitalized at Sahlgrenska University Hospital/Ostra for HF were consecutively included between May 2007 and April 2008. Diagnosis were reviewed and re-evaluated for each patient. The outcome measure was all-cause mortality and collected from May 2007 and 2013. Results: Mean age of the study population ( n = 289) was 79 ± 7 years. One third of the HF cohort had HFpEF. When adjusted for age HFrEF patients had a 42% higher 5-year mortality than HFpEF. By logistic regression analysis age, female sex, pulmonary disease, renal dysfunction, loop diuretics and aldosterone receptor antagonist were negatively associated with prognosis in HFpEF, whereas angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARBs) and Statins were positive prognostic factors. In HFrEF age, atrial fibrillation, NT-proBNP and loop diuretics were negative predictive factors, while treated hypertension, percutaneous coronary intervention, ACEi/ARBs and beta-blockers were positive factors for survival. Conclusion: HFpEF proved to have a better long-term prognosis than HFrEF and a distinct prognostic risk profile. Highlights: Probably the first study to compare long-term prognosis of HFrEF vs HFpEF in the elderly on contemporary HF therapy. Prognosis is poor in both groups but 42% worse in HFrEF patients than HFpEF. Prognostic factors associated with outcome differs between HFrEF and HFpEF. Our results differ from previous studies where HF was defined differently and suboptimal HF therapy were used.