Ovidiu Chioncel1, Mitja Lainscak2, Petar M Seferovic3, Stefan D Anker4, Maria G Crespo-Leiro5, Veli-Pekka Harjola6, John Parissis7, Cecile Laroche8, Massimo Francesco Piepoli9, Candida Fonseca10, Alexandre Mebazaa11, Lars Lund12, Giuseppe A Ambrosio13, Andrew J Coats14, Roberto Ferrari15, Frank Ruschitzka16, Aldo P Maggioni17, Gerasimos Filippatos18. 1. University of Medicine Carol Davila, Bucuresti; Institutul de Urgente Boli Cardiovasculare C.C.Iliescu, Bucuresti, Romania. 2. Department of Cardiology, General Hospital Celje, Slovenia. 3. Department of Internal Medicine, Belgrade University School of Medicine and Heart Failure Centre, Belgrade University Medical Centre, Belgrade, Serbia. 4. Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany. 5. Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC, LaCoruna, Spain. 6. Emergency Medicine, Helsinki University, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland. 7. Attikon University Hospital, Athens, Greece. 8. EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France. 9. Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, AUSL Piacenza, Italy. 10. Heart Failure Unit, S. Francisco Xavier Hospital, Centro Hospitalar Lisboa Ocidental. NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal. 11. University Paris Diderot, Sorbonne Paris Cité, Paris, France; 4APHP, Department of Anaesthesia and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Paris, France. 12. Karolinska Institutet, Department of Medicine and Karolinska University Hospital, Stockholm, Sweden. 13. University of Perugia School of Medicine, Perugia, Italy. 14. Monash University, Australia and University of Warwick, Coventry, UK. 15. Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care and Research, ES Health Science Foundation, Cotignola, Italy. 16. Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Centre Zurich, Zurich, Switzerland. 17. ANMCO Research Center, Florence, Italy. 18. National and Kapodistrian University of Athens, School of Medicine, University Hospital Attikon, Athens, Greece.
Abstract
AIMS: The objectives of the present study were to describe epidemiology and outcomes in ambulatory heart failure (HF) patients stratified by left ventricular ejection fraction (LVEF) and to identify predictors for mortality at 1 year in each group. METHODS AND RESULTS: The European Society of Cardiology Heart Failure Long-Term Registry is a prospective, observational study collecting epidemiological information and 1-year follow-up data in 9134 HF patients. Patients were classified according to baseline LVEF into HF with reduced EF [EF <40% (HFrEF)], mid-range EF [EF 40-50% (HFmrEF)] and preserved EF [EF >50% (HFpEF)]. In comparison with HFpEF subjects, patients with HFrEF were younger (64 years vs. 69 years), more commonly male (78% vs. 52%), more likely to have an ischaemic aetiology (49% vs. 24%) and left bundle branch block (24% vs. 9%), but less likely to have hypertension (56% vs. 67%) or atrial fibrillation (18% vs. 32%). The HFmrEF group resembled the HFrEF group in some features, including age, gender and ischaemic aetiology, but had less left ventricular and atrial dilation. Mortality at 1 year differed significantly between HFrEF and HFpEF (8.8% vs. 6.3%); HFmrEF patients experienced intermediate rates (7.6%). Age, New York Heart Association (NYHA) class III/IV status and chronic kidney disease predicted mortality in all LVEF groups. Low systolic blood pressure and high heart rate were predictors for mortality in HFrEF and HFmrEF. A lower body mass index was independently associated with mortality in HFrEF and HFpEF patients. Atrial fibrillation predicted mortality in HFpEF patients. CONCLUSIONS: Heart failure patients stratified according to different categories of LVEF represent diverse phenotypes of demography, clinical presentation, aetiology and outcomes at 1 year. Differences in predictors for mortality might improve risk stratification and management goals.
AIMS: The objectives of the present study were to describe epidemiology and outcomes in ambulatory heart failure (HF) patients stratified by left ventricular ejection fraction (LVEF) and to identify predictors for mortality at 1 year in each group. METHODS AND RESULTS: The European Society of Cardiology Heart Failure Long-Term Registry is a prospective, observational study collecting epidemiological information and 1-year follow-up data in 9134 HF patients. Patients were classified according to baseline LVEF into HF with reduced EF [EF <40% (HFrEF)], mid-range EF [EF 40-50% (HFmrEF)] and preserved EF [EF >50% (HFpEF)]. In comparison with HFpEF subjects, patients with HFrEF were younger (64 years vs. 69 years), more commonly male (78% vs. 52%), more likely to have an ischaemic aetiology (49% vs. 24%) and left bundle branch block (24% vs. 9%), but less likely to have hypertension (56% vs. 67%) or atrial fibrillation (18% vs. 32%). The HFmrEF group resembled the HFrEF group in some features, including age, gender and ischaemic aetiology, but had less left ventricular and atrial dilation. Mortality at 1 year differed significantly between HFrEF and HFpEF (8.8% vs. 6.3%); HFmrEF patients experienced intermediate rates (7.6%). Age, New York Heart Association (NYHA) class III/IV status and chronic kidney disease predicted mortality in all LVEF groups. Low systolic blood pressure and high heart rate were predictors for mortality in HFrEF and HFmrEF. A lower body mass index was independently associated with mortality in HFrEF and HFpEF patients. Atrial fibrillation predicted mortality in HFpEF patients. CONCLUSIONS:Heart failurepatients stratified according to different categories of LVEF represent diverse phenotypes of demography, clinical presentation, aetiology and outcomes at 1 year. Differences in predictors for mortality might improve risk stratification and management goals.
Authors: Ambarish Pandey; Muthiah Vaduganathan; Sameer Arora; Arman Qamar; Robert J Mentz; Sanjiv J Shah; Patricia P Chang; Stuart D Russell; Wayne D Rosamond; Melissa C Caughey Journal: Circulation Date: 2020-06-03 Impact factor: 29.690