Outcomes poor after HF hospitalization for patients with mildly reduced, preserved EF
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Key takeaways:
- In the year after HF hospitalization, more than 25% of patients with HF with mildly reduced and preserved EF died.
- More than 50% were rehospitalized and more than 50% experienced a major adverse CV event.
Patients with heart failure with preserved ejection fraction and those with HF and mildly reduced EF experienced similarly poor outcomes and mortality rates over 12 months follow-up after HF hospitalization, researchers reported.
A research letter that evaluated the patient characteristics, treatment patterns and in-hospital and post-discharge outcomes among patients across the range of mildly reduced and preserved EF was published in Circulation: Heart Failure. Participants were hospitalized between 2010 and 2020, prior to the class 2A guideline recommendation of SGLT2 inhibitors as treatment for this population.
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“Although efficacy of multiple heart failure medications is now proven to extend to patients with left ventricular ejection fraction > 40%, the clinical benefits are often attenuated as LVEF increases within this range,” Stephen J. Greene, MD, advanced heart failure specialist at the Duke Clinical Research Institute, and colleagues wrote. “Understanding the real-world patient profile across the range of mildly reduced and preserved LVEF may inform implementation and applicability of clinical trial data to routine practice.”
Greene and colleagues leveraged real-world data from the Optum electronic medical record database to compare patient characteristics, treatment patterns and in-hospital and post-discharge outcomes among 6,335 patients hospitalized for HF with LVEF of 41% to 49%; 18,603 with LVEF of 50% to 59%; and 22,088 with LVEF of 60% or more (median age, 77 years; 58% women; 84% white).
The group of patients with LVEF of 60% or more had the highest proportion of women (64.9%), the lowest N-terminal pro-B-type natriuretic peptide concentration (median, 2,234 pg/mL) and lowest rates of CAD (31.5%) and atrial fibrillation (34.4%), according to the study.
The group of patients with LVEF 41% to 49% had the lowest proportion of women (45.2%) and the highest NT-proBNP concentration (median, 4,221 pg/mL), according to the study.
After 2 days, use of mechanical therapy and IV inotropes were similar across LVEF groups and the median duration of IV diuretic therapy was 3 days.
At hospital discharge, the rate of mineralocorticoid receptor antagonist use was 10.5% and the rate of angiotensin receptor/neprilysin inhibitor use was 0.3%, with slightly greater use among patients with LVEF 41% to 49%, the researchers reported.
In addition, hospital stay (median length, 4 days), in-hospital mortality and post-discharge outcomes at 30 days and 12 months were similarly poor across LVEF groups. More than 25% of patients died, more than 50% were rehospitalized and more than 50% experienced a major adverse CV event during 12 months follow-up, according to the research letter.
“Despite differences in clinical profile, outcomes were similarly poor, irrespective of LVEF,” the researchers wrote. “In the 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America HF guidelines, apart from class 2A recommendations for sodium-glucose cotransporter-2 inhibitor therapy, multiple medications traditionally indicated for HFrEF now carry class 2B recommendations for HF with mildly reduced LVEF and HFpEF. ... Among patients in the current analysis with true HFpEF 50%, more than half (54%) had LVEF 60%, which may inform applicability or anticipated population-level benefit with implementation of new class 2B medication recommendations for HFpEF.”
References:
- Heidenreich PA, et al. Circulation. 2022;doi:10.1161/CIR.0000000000001063.
- Heidenreich PA, et al. J Am Coll Cardiol. 2022;doi:10.1016/j.jacc.2021.12.012.
- Heidenreich PA, et al. J Card Fail. 2022;doi:10.1016/j.cardfail.2022.02.010.
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