Dimitrios Farmakis1, Panagiotis Simitsis1, Vasiliki Bistola1, Filippos Triposkiadis2, Ignatios Ikonomidis1, Spyridon Katsanos1, George Bakosis1, Erifili Hatziagelaki1, John Lekakis1, Alexandre Mebazaa3, John Parissis4. 1. Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece. 2. Department of Cardiology, Larissa University Hospital, Larissa, Greece. 3. Department of Anesthesiology and Intensive Care, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France. 4. Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece. jparissis@yahoo.com.
Abstract
BACKGROUND: Heart failure with mid-range left ventricular ejection fraction (HFmrEF) is a poorly characterized population as it has been studied either in the context of HF with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF) depending on applied LVEF cutoffs. We sought to investigate the clinical profile, in-hospital management, and short-term outcome of HFmrEF patients in comparison with those with HFrEF or HFpEF in a large acute HF cohort. METHODS AND RESULTS: The Acute Heart Failure Global Registry of Standard Treatment (ALARM-HF) included 4953 patients hospitalized for HF in nine countries in Europe, Latin America, and Australia. Baseline characteristics, clinical presentation, in-hospital therapies, and short-term mortality (all-cause in-hospital or 30-day mortality, whichever first) were compared among HFrEF (LVEF <40%), HFmrEF (LVEF 40-49%), and HFpEF (LVEF ≥50%) patients. Among 3257 patients with documented LVEF, 52% had HFrEF, 25% HFmrEF, and 23% HFpEF. Patients with HFmrEF had a distinct demographic and clinical profile with many intermediate features between HFrEF and HFpEF. In addition, they had a higher prevalence of hypertension (p < 0.001), a lower prevalence of chronic renal disease (p = 0.003), more hospitalizations for acute coronary syndrome (p < 0.001), or infection (p = 0.003), and were more frequently treated with intravenous vasodilators compared to HFrEF or HFpEF. Adjusted short-term mortality in HFmrEF was lower than HFrEF [hazard ratio (HR) = 0.635 (0.419, 0.963), p = 0.033] but similar to HFpEF [HR = 1.026 (0.605, 1.741), p = 0.923]. CONCLUSION: Hospitalized HFmrEF patients represent a demographically and clinically diverse group with many intermediate features compared to HFrEF and HFpEF and carry a lower risk of short-term mortality than HFrEF but a similar risk with HFpEF.
BACKGROUND:Heart failure with mid-range left ventricular ejection fraction (HFmrEF) is a poorly characterized population as it has been studied either in the context of HF with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF) depending on applied LVEF cutoffs. We sought to investigate the clinical profile, in-hospital management, and short-term outcome of HFmrEF patients in comparison with those with HFrEF or HFpEF in a large acute HF cohort. METHODS AND RESULTS: The Acute Heart Failure Global Registry of Standard Treatment (ALARM-HF) included 4953 patients hospitalized for HF in nine countries in Europe, Latin America, and Australia. Baseline characteristics, clinical presentation, in-hospital therapies, and short-term mortality (all-cause in-hospital or 30-day mortality, whichever first) were compared among HFrEF (LVEF <40%), HFmrEF (LVEF 40-49%), and HFpEF (LVEF ≥50%) patients. Among 3257 patients with documented LVEF, 52% had HFrEF, 25% HFmrEF, and 23% HFpEF. Patients with HFmrEF had a distinct demographic and clinical profile with many intermediate features between HFrEF and HFpEF. In addition, they had a higher prevalence of hypertension (p < 0.001), a lower prevalence of chronic renal disease (p = 0.003), more hospitalizations for acute coronary syndrome (p < 0.001), or infection (p = 0.003), and were more frequently treated with intravenous vasodilators compared to HFrEF or HFpEF. Adjusted short-term mortality in HFmrEF was lower than HFrEF [hazard ratio (HR) = 0.635 (0.419, 0.963), p = 0.033] but similar to HFpEF [HR = 1.026 (0.605, 1.741), p = 0.923]. CONCLUSION: Hospitalized HFmrEF patients represent a demographically and clinically diverse group with many intermediate features compared to HFrEF and HFpEF and carry a lower risk of short-term mortality than HFrEF but a similar risk with HFpEF.
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