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Long-term outcomes comparable for diastolic, systolic HF
New research indicates that long-term outcomes are similar for patients who have HF with preserved ejection fraction and those who have HF with reduced ejection fraction.
Researchers conducted a study to characterize the prevalence, treatment and outcomes of patients hospitalized and discharged with a diagnosis of acute decompensated HF from December 2006 to September 2008 (n=1,097; 45% women; 45% black; mean age, 67 years). HF with preserved ejection fraction (HFpEF) was classified as LVEF ≥50% and HF with reduced ejection fraction (HFrEF) was classified as LVEF <50%.
Patients with HFpEF were older, more likely to be women and to have underlying hypertension than patients with HFrEF, according to Rene Quiroz, MD, MPH, of Boston University Medical Center, and colleagues.
Upon admission, patients with HFpEF were more hypertensive than those with HFrEF (150 mm Hg vs. 142 mm Hg), but had less tachycardia (80 bpm vs. 89 bpm). Those with HFpEF also had higher creatinine levels than those with HFrEF (1.82 mg/dL vs. 1.58 mg/dL), but lower brain natriuretic peptide levels (679 pg/mL vs. 1,380 pg/mL) and hemoglobin levels (11.95 g/dL vs. 12.4 g/dL), the researchers found.
Patients with HFpEF were less likely than those with HFrEF to be prescribed on discharge with ACE inhibitors (48% vs. 65%), beta-blockers (77% vs. 87%), spironolactone (2% vs. 8%) or long-acting nitrates (17% vs. 31%); however, there was no difference in prescriptions for angiotensin receptor blockers.
There was no difference in in-hospital mortality between the groups (HFpEF, 2.7%; HFrEF, 3.9%; P=.3), according to the researchers.
The 30-day readmission rate was lower for patients with HFpEF than those with HFrEF (5% vs. 11%; P<.001), but there was no difference in the readmission-free rate at 1 year (67% vs. 61.6%; P=.18).
Rates of death during the study period were similar between the groups (P=.46). All-cause mortality at 30 days was 2.7% for patients with HFpEF vs. 3% for patients with HFrEF (P=.74), whereas 1-year mortality rates also were comparable (HFpEF, 17.1%; HFrEF, 18.2%; P=.34), the researchers wrote.
“Lower 30-day readmissions do not translate into improved long-term outcome in patients with [HFpEF],” Quiroz and colleagues wrote.
Disclosure: The researchers report no relevant financial disclosures.