Gianluigi Savarese1, Ola Vedin2, Domenico D'Amario3, Alicia Uijl4, Ulf Dahlström5, Giuseppe Rosano6, Carolyn S P Lam7, Lars H Lund1. 1. Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden. 2. Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden; Boehringer Ingelheim AB, Stockholm, Sweden. Electronic address: ola.vedin@medsci.uu.se. 3. Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli Institute of Scientific Research and Treatment, Università Cattolica del Sacro Cuore, Rome, Italy. 4. Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 5. Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden. 6. Department of Medical Sciences, IRCCS San Raffaele Hospital, Rome, Italy. 7. National Heart Centre Singapore, Duke-NUS Medical School, and University Medical Centre Groningen, Groningen, the Netherlands.
Abstract
OBJECTIVES: This study sought to evaluate the incidence, the predictors, and the associations with outcomes of changes in ejection fraction (EF) in heart failure (HF) patients. BACKGROUND: EF determines therapy in HF, but information is scarce about incidence, determinants, and prognostic implications of EF change over time. METHODS: Patients with ≥2 EF measurements were made in the Swedish Heart Failure Registry were categorized as heart failure with preserved ejection fraction (HFpEF) (EF ≥50%), heart failure with midrange ejection fraction (HFmrEF) (EF 40% to 49%), or heart failure with reduced ejection fraction (HFrEF) (EF <40%). Changes among categories were recorded, and associations among EF changes, predictors, and all-cause mortality and/or HF hospitalizations were analyzed using logistic and Cox regressions. RESULTS: Of 4,942 patients at baseline, 18% had HFpEF, 19% had HFmrEF, and 63% had HFrEF. During follow-up, 21% and 18% of HFpEF patients transitioned to HFmrEF and HFrEF, respectively; 37% and 25% of HFmrEF patients transitioned to HFrEF and HFpEF, respectively; and 16% and 10% of HFrEF patients transitioned to HFmrEF and HFpEF, respectively. Predictors of increased EF included female sex, cases of less severe HF, and comorbidities. Predictors of decreased EF included diabetes, ischemic heart disease, and cases of more severe HF. Use of renin-angiotensin-system inhibitors was associated with lower likelihood of EF increase, but not with EF decrease, i.e., stable EF. Increased EF was associated with a lower risk (hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.55 to 0.69) and decreased EF with a higher risk (HR: 1.15; 95% CI: 1.01 to 1.30) of mortality and/or HF hospitalizations. Prognostic implications were most evident for transitions to and from HFrEF. CONCLUSIONS: Increases in EF occurred in one-fourth of HFrEF and HFmrEF patients, and decreases occurred in more than one-third of patients with HFpEF and HFmrEF. EF change was associated with a wide range of important clinical and organizational factors as well as with outcomes, particularly transitions to and from HFrEF.
OBJECTIVES: This study sought to evaluate the incidence, the predictors, and the associations with outcomes of changes in ejection fraction (EF) in heart failure (HF) patients. BACKGROUND: EF determines therapy in HF, but information is scarce about incidence, determinants, and prognostic implications of EF change over time. METHODS:Patients with ≥2 EF measurements were made in the Swedish Heart Failure Registry were categorized as heart failure with preserved ejection fraction (HFpEF) (EF ≥50%), heart failure with midrange ejection fraction (HFmrEF) (EF 40% to 49%), or heart failure with reduced ejection fraction (HFrEF) (EF <40%). Changes among categories were recorded, and associations among EF changes, predictors, and all-cause mortality and/or HF hospitalizations were analyzed using logistic and Cox regressions. RESULTS: Of 4,942 patients at baseline, 18% had HFpEF, 19% had HFmrEF, and 63% had HFrEF. During follow-up, 21% and 18% of HFpEF patients transitioned to HFmrEF and HFrEF, respectively; 37% and 25% of HFmrEF patients transitioned to HFrEF and HFpEF, respectively; and 16% and 10% of HFrEF patients transitioned to HFmrEF and HFpEF, respectively. Predictors of increased EF included female sex, cases of less severe HF, and comorbidities. Predictors of decreased EF included diabetes, ischemic heart disease, and cases of more severe HF. Use of renin-angiotensin-system inhibitors was associated with lower likelihood of EF increase, but not with EF decrease, i.e., stable EF. Increased EF was associated with a lower risk (hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.55 to 0.69) and decreased EF with a higher risk (HR: 1.15; 95% CI: 1.01 to 1.30) of mortality and/or HF hospitalizations. Prognostic implications were most evident for transitions to and from HFrEF. CONCLUSIONS: Increases in EF occurred in one-fourth of HFrEF and HFmrEF patients, and decreases occurred in more than one-third of patients with HFpEF and HFmrEF. EF change was associated with a wide range of important clinical and organizational factors as well as with outcomes, particularly transitions to and from HFrEF.
Authors: Benjamin A Steinberg; Zhen Li; Peter Shrader; Derek S Chew; T Jared Bunch; Daniel B Mark; Yelena Nabutovsky; Rashmee U Shah; Melissa A Greiner; Jonathan P Piccini Journal: Am Heart J Date: 2021-11-25 Impact factor: 4.749
Authors: Tarun W Dasari; Tamas Csipo; Faris Amil; Agnes Lipecz; Gabor A Fulop; Yunqiu Jiang; Rajesh Samannan; Sarah Johnston; Yan D Zhao; Federico Silva-Palacios; Stavros Stavrakis; Andriy Yabluchanskiy; Sunny S Po Journal: J Card Fail Date: 2020-12-31 Impact factor: 6.592