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Acute Heart Failure: does midrange ejection fraction result in midrange prognosis?
Session:
CO 22- Insuficiência cardíaca aguda
Speaker:
João Borges Rosa
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Borges Rosa; Gustavo m. Campos; Sofia Martinho; José Lopes de Almeida; Valdirene Gonçalves; Cátia Ferreira; André Azul Freitas; James Milner; João André Ferreira; Ana Vera Marinho; Patrícia m. Alves; Manuel Oliveira-Santos; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Heart failure with midrange ejection fraction (HFmrEF) has recently been recognized and there is limited data regarding mortality outcomes compared to heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction. We aimed to evaluate whether HFmrEF has a different prognosis after an acute heart failure (AHF) episode, in a real-world contemporaneous southern European population.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We retrospectively studied 1026 patients admitted to our emergency department between November 2016 and December 2017 with discharge diagnosis of AHF. Median follow up was 5 months (IQR 3-11 months). Incidence of rehospitalization, cardiovascular (CV) and all-cause mortality were evaluated through multivariable logistic regression models and by Kaplan-Meyer survival curves.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> From all patients, 782 were categorized in HFrEF (34.1%), HFmrEF (19.4%) and HFpEF (46.4%). There was heterogeneity between groups. Compared to HFrEF, HFmrEF patients were older (80[74-84] vs. 76[67-82] years, p<0.001), with lower prevalence of males (61.2% vs. 76.4%, p=0.004) and coronary artery disease (CAD) (35.5% vs. 47.6%, p=0.024), but higher rates of valvular heart disease (VHD) (48.0% vs. 29.6%, p<0.001). Compared to HFpEF, HFmrEF subjects had higher prevalence of males (61.2% vs. 40.8%, p<0.001) and CAD (35.5% vs. 13.2%, p<0.001). At admission, patients with HFmrEF and HFrEF had similar serum creatinine e B-type natriuretic peptide values, but higher than the HFpEF group: 1.38±0.7 vs. 1.45±0.7 vs. 1.28±0.8mg/dL, p=0.019 and 701 [385-1191] vs. 1000 [494-1776] vs. 360 [214-717]pg/mL, p<0.001, respectively. HFmrEF patients had higher rates of hospitalization (71.7% vs. 43.8%, p<0.001), follow-up readmissions (27.6% vs. 18.7%, p=0.034), CV (11.8% vs. 5.0%, p=0.025) and all-cause mortality (25.7% vs. 14.9%, p=0.015), compared to HFpEF; no differences comparatively to HFrEF. There was no difference between groups regarding the length of hospitalization (9 [5-15] vs. 8 [5-15] vs. 10 [6-17] days, p=0.302). In multivariate logistic regression model adjusted for age, sex, SBP, CAD, VHD, creatinine, and BNP, HFmrEF increased the risk of CV (OR 2.9, 95% CI 1.2-6.7, p=0.016) and all-cause mortality (OR 2.1, 95% CI 1.2-3.9, p=0.011), but not follow-up readmissions (OR 1.7, 95% CI 0.9-2.9, p=0.059). <span style="background-color:white"><span style="color:#2a2a2a">Kaplan-Meier estimates of </span></span>CV,<span style="background-color:white"><span style="color:#2a2a2a"> and all-cause mortality are shown in Figure 1. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> HFmrEF have a similar short-term prognosis to HFrEF and worse than HFpEF, with more readmissions, CV and all-cause mortality, after an AHF episode. Whether this feature is valid in the long-term needs to be ascertained by other studies.</span></span></p>
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