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Heart Failure with mid range ejection fraction in real life Heart Failure population: a true different class?
Session:
Painel 2- Insuficiencia cardiaca 4
Speaker:
Luís Landeiro
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.1 Chronic Heart Failure – Pathophysiology and Mechanisms
Session Type:
Posters
FP Number:
---
Authors:
Luís Mão De Ferro Landeiro; Sara Trevas; João Presume; Margarida Madeira; Marta Roldão; Inês Silva; Luís Campos; Catarina Rodrigues; Inês Araújo; Cândida Fonseca
Abstract
<p>Background: In 2016, European Society of Cardiology introduced a new category of heart failure (HF), with mid-range ejection fraction (EF) between 40% and 49% (HFmrEF), to stimulate investigation on this poorly defined type of HF. Data is still nonconsensual. We aim to describe HFmrEF patients (pts), as well as its comparison to other types of HF, in what regards its clinical characteristics, comorbidities and prognosis.</p> <p>Methods: We retrospectively analyzed clinical characteristics, comorbidities and mortality of 359 patients consecutively admitted in an acute HF Unit and compared HFmrEF to HFrEF and HFpEF.</p> <p>Results: Of the 359 pts, m=76,5±11,6 years, 46 had HFmrEF (12,8%; m=74,5±14,6y), 106 HFrEF (29,5%; m=71,1±12,3y) and 207 HFpEF (57,7%; m=79,8±9,2y). Regarding gender, the HFrEF pts were predominantly male (67%) and the HFpEF predominantly female (59%), with no gender predominance in HFmrEF or in the global population.</p> <p>Regarding HFmrEF, hypertensive heart disease was the main etiology of HF(n=20; 44% vs 59% HFpEF vs 10% HFrEF), followed by ischemic heart disease (IHD) (n=13; 28% vs 18% HFpEF vs 62% HFrEF).</p> <p>Regarding comorbidities of HFmrEF pts, 83% had hypertension (vs HFpEF 88% vs HFrEF 65%), 65% atrial fibrillation (AF) (vs HFpEF 65% vs HFrEF 50%), 59% hypercholesterolemia (vs HFpEF 50% vs HFrEF 54%), 48% were obese / excessive weight (vs HFpEF 70% vs HFrEF 55%), 35% diabetes (vs HFpEF 41% vs HFrEF 41%), 33% chronic kidney disease (vs HFpEF 44% vs HFrEF 41%) and 17% chronic obstructive pulmonary disease (vs HFpEF 26% vs HFrEF 20%).</p> <p>The average number of comorbidities were 4 (including all the above, cerebrovascular, thyroid, hepatic or concomitant malignant diseases, obstructive sleep apnea, alcohol or cigarrete consumption) in all three types of HF.</p> <p>Concerning medication at admission, there was increasingly higher usage of beta blockers, angiotensin-converting enzyme inhibitors (ACEi) / angiotensin II receptor blockers (ARb) / angiotensin receptor-neprilysin inhibitor (ARNi) and mineralocorticoid receptor antagonists (MRA) from HFpEF, to HFmrEF and HFrEF – beta blockers 53, 61, 72%; ACEi / ARb / ARNi 62, 70, 75%; MRA 15, 28, 45%. Diuretics were used in above 70% in all groups, slightly higher in HFrEF.</p> <p>Regarding mortality, 10 pts with HFmrEF died within the first two years (22%), 70% from HF. Mortality rates of HFrEF and HFpEF was 25% (n=26; 65% from HF) and 34% (n=70; 55% from HF), respectively.</p> <p>Conclusion: Regarding age and etiology of HF, HFmrEF had intermediate characteristics in between the other two groups, which have a clear predominant causing factor – hypertension for HFpEF and IHD for HFrEF. HFmrEF is much closer to HFpEF in regard to incidence of hypertension and AF. Number and incidence of comorbidities were similar within all groups. Disease modifying therapy for HFrEF is increasingly used as EF lowers. HFmrEF had a lower mortality than HFpEF within the first two years, similar to HFrEF.</p>
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