Comparison of Characteristics and 3-Year Outcomes in Patients With Acute Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction

Cho, Jun Hwan; Choe, Won Seok; Cho, Hyun Jai; Lee, Hae Young; Jang, Jieun; Lee, Sang Eun; Choi, Jin Oh; Jeon, Eun Seok; Kim, Min Seok; Hwang, Kyung Kuk; Chae, Shung Chull; Baek, Sang Hong; Kang, Seok Min; Choi, Dong Ju; Yoo, Byung Su; Kim, Kye Hun; Cho, Myeong Chan; Kim, Jae Joong; Oh, Byung Hee

doi:10.1253/circj.cj-18-0543

Cited by 40 publications

(59 citation statements)

References 29 publications

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“…Third, our study is also first in the literature analysing very elderly patients with HFmrEF. Previous studies have shown that patients with HFmrEF had clinical characteristics intermediate between those in the HFrEF and HFpEF groups . The similar characteristics to those with HFpEF include older age, female sex, comorbidities (hypertension, chronic obstructive pulmonary disease, diabetes mellitus and laboratory values ‐BNP and troponin‐) and medication use (beta‐blockers, ACE‐Is and ARBs) .…”

Section: Discussionmentioning

confidence: 97%

Clinical features of heart failure with mid‐range and preserved ejection fraction in octogenarians: Results of a multicentre, observational study

Özlek

Tekinalp

et al. 2019

Int J Clin Pract

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Summary Objectives To compare real‐world characteristics and management of individuals aged 80 and older with heart failure (HF) and mid‐range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) derived from a large cohort of survey and to compare them with those younger than 80 from the same survey. Methods This is an observational, multicentre and cross‐sectional study conducted in Turkey (NCT03026114). Consecutive 1065 (mean age of 67.1 ± 10.6 years) patients admitted to the cardiology outpatient units with HFmrEF and HFpEF were included. Results Participants aged 80 and older (n = 123, 11.5%) were more likely to be female (66.7% vs 52.5%, P = 0.003), had a higher prevalence of atrial fibrillation (49.6% vs 34%, P = 0.001), and anaemia (46.3% vs 33.4%, P = 0.005) than those who were younger than 80. N‐terminal pro B‐type natriuretic peptide levels were higher in those aged 80 and older than in those younger than 80 (1037 vs 550 pg/ml, P < 0.001). The prescription rates of HF medications (including in ACE‐Is/ARBs, β‐blockers, MRAs, digoxin, ivabradine and diuretics) were similar (P > 0.05) in both groups. Octogenarians did not significantly differ from younger patients in the prevalence of HFmrEF (24.4% vs 22.9%) and HFpEF (75.6% vs 77.1%). Coronary artery disease was associated with HFmrEF (P < 0.05), whereas atrial fibrillation was associated with HFpEF (P < 0.05) in octogenarians. Conclusions This study revealed that nearly 12% of the individuals with HFmrEF and HFpEF in this real‐world sample were aged 80 and older. Participants aged 80 and older are more likely to be female and have more comorbidities than those who were younger than 80. However, HF medication profiles were similar in both groups. This study also showed that associated factors with HFmrEF and HFpEF were differ in octogenarians.

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Section: Discussionmentioning

confidence: 97%

Clinical features of heart failure with mid‐range and preserved ejection fraction in octogenarians: Results of a multicentre, observational study

Özlek

Tekinalp

et al. 2019

Int J Clin Pract

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“…17,19 On the other hand, a meta-analysis demonstrated that HFmrEF had a lower rate of cardiac mortality than HFrEF. 20 This discrepancy might be due to the difference in patient characteristics and treatment in each cohort.…”

Section: Discussionmentioning

confidence: 99%

Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction

et al. 2020

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Aims Spironolactone has been shown to improve outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). We investigated whether the discharge use of spironolactone could be associated with better long‐term outcomes among patients with HF with mid‐range EF (HFmrEF). Methods and results We analysed HFmrEF (left ventricular EF 40–49%) patients enrolled in the Japanese Cardiac Registry of Heart Failure in Cardiology, which prospectively studied the clinical characteristics, treatments, and long‐term outcomes of patients hospitalized due to HF. Patients were divided into two groups according to the use of spironolactone at discharge. The primary outcome was a composite of all‐cause death or HF rehospitalization. A total of 457 patients had HFmrEF. The mean age was 69.3 years and 286 (62.6%) were male. Among them, spironolactone was prescribed at discharge in 158 patients (34.6%). Chronic kidney disease (7.6% vs. 16.8%, P = 0.007) was less prevalent and loop diuretics (89.2% vs. 70.2%, P < 0.001) were more often prescribed in patients with spironolactone. During a mean follow‐up of 2.2 years, patients with spironolactone had a lower incidence rate of the primary outcome than those without it (171.5 vs. 278.8 primary outcome per 1000 patient‐years, incidence rate ratio 0.61, 95% confidence interval 0.44–0.86; P = 0.004). After multivariable adjustment, spironolactone use at discharge was associated with a significant reduction in the composite of all‐cause death or HF rehospitalization (adjusted hazard ratio 0.63, 95% confidence interval 0.44–0.90, P = 0.010). Conclusions Among patients with HF hospitalized for HFmrEF, spironolactone use at discharge was associated with better long‐term outcomes.

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“…22 In an acute heart failure study, Cho et al found higher in-hospital mortality and lower long-term survival rates in the rEF than mrEF and pEF groups with non-ischemic etiology. 21 Fonarow et al reported a higher prevalence of heart failure with pEF and similar mortality and rehospitalization rates regardless of LVEF category after discharge. 23 Various conclusions were made regarding the prognosis in heart failure patients in terms of LVEF differences; nevertheless, there was no definite confirmation.…”

Section: Disclosuresmentioning

confidence: 93%

Prognostic Significance of Post-Procedural Left Ventricular Ejection Fraction Following Atrial Fibrillation Ablation in Patients With Systolic Dysfunction

et al. 2020

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Study Population This retrospective observational study screened 1,077 consecutive patients undergoing radiofrequency catheter ablation for AF (Figure 1). Of patients undergoing circumferential pulmonary vein isolation (PVI) between August 2009 and May 2019, 195 who had impaired LVEF (<50%) were enrolled in the present study. Patients who underwent cardiac resynchronized therapy after the procedure, those who were followed up for <6 months after the procedure, and those who did not receive echocardiographic evaluations 3 months after the index procedure were excluded. AF ablation was indicated based on previous expert consensus statements. 7-9 Within the 1 month prior to each session, patients underwent 3-dimensional cardiac computed A trial fibrillation (AF) is often associated with impaired left ventricular ejection fraction (LVEF) and poor prognosis due to the absence of atrioventricular synchrony, a deficiency of atrial kick, irregularity, or tachycardia. 1 Several randomized control studies have reported that AF ablation is associated with a good prognosis and significant LVEF improvement. 2,3 In addition, several studies have reported predictors of LVEF improvement after AF ablation in heart failure patients. 4-6 Nevertheless, the definition of LVEF improvement varies among studies, meaning that the relationship between LVEF improvement and prognosis is not clear. Therefore, the aim of the present study was to investigate the relationship between post-procedural LVEF (3 months after the procedure) and prognosis in patients who underwent AF ablation.

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Comparison of Characteristics and 3-Year Outcomes in Patients With Acute Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction

Cited by 40 publications

References 29 publications

Clinical features of heart failure with mid‐range and preserved ejection fraction in octogenarians: Results of a multicentre, observational study

Clinical features of heart failure with mid‐range and preserved ejection fraction in octogenarians: Results of a multicentre, observational study

Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction

Prognostic Significance of Post-Procedural Left Ventricular Ejection Fraction Following Atrial Fibrillation Ablation in Patients With Systolic Dysfunction

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