TY - JOUR
T1 - Comparison of Clinical Features and Outcomes of Patients Hospitalized With Heart Failure and Normal Ejection Fraction (≥55%) Versus Those With Mildly Reduced (40% to 55%) and Moderately to Severely Reduced (<40%) Fractions
AU - Sweitzer, Nancy K.
AU - Lopatin, Margarita
AU - Yancy, Clyde W.
AU - Mills, Roger M.
AU - Stevenson, Lynne W.
N1 - Funding Information:
Dr. Sweitzer is funded in part through Grant AG01022 K23 from the National Institutes of Health, Bethesda, Maryland. Heart failure
PY - 2008/4/15
Y1 - 2008/4/15
N2 - Heart failure (HF) with normal ejection fraction (EF) is an increasingly common presentation of acute decompensated HF. Differences between patients with HF and truly normal EF and those with mildly impaired EF have not been described. The Acute Decompensated Heart Failure Registry (ADHERE) contains information on >100,000 HF hospitalizations and may provide insight into this distinction. The ADHERE database was used to investigate differences between patients hospitalized with HF and severely (<25%), moderately (25% to 40%), and mildly (40% to 55%) decreased EF and those with normal EF (≥55%). The group with normal EF was 69% women with a mean age of 74 years (p <0.0001 vs all other groups). Coronary artery disease was less frequent in the normal EF group, and hypertension played a larger role. Patients with EF ≥55% had increased pulse pressure, suggesting a role for arterial stiffening. Treatment differed by EF. Creatinine increased ≥0.5 mg/dl more often in the group with HF and normal EF than in the group with HF and severely decreased EF. In-hospital mortality and length of stay in the intensive care unit varied inversely with EF; overall length of stay was similar. In conclusion, patients with HF and normal EF are more likely to be women, have a history of high pulse pressure hypertension, less coronary artery disease, and a lower risk of inpatient death but a higher likelihood of deterioration in renal function during hospitalization. These observations may be important considerations in the design of future clinical trials.
AB - Heart failure (HF) with normal ejection fraction (EF) is an increasingly common presentation of acute decompensated HF. Differences between patients with HF and truly normal EF and those with mildly impaired EF have not been described. The Acute Decompensated Heart Failure Registry (ADHERE) contains information on >100,000 HF hospitalizations and may provide insight into this distinction. The ADHERE database was used to investigate differences between patients hospitalized with HF and severely (<25%), moderately (25% to 40%), and mildly (40% to 55%) decreased EF and those with normal EF (≥55%). The group with normal EF was 69% women with a mean age of 74 years (p <0.0001 vs all other groups). Coronary artery disease was less frequent in the normal EF group, and hypertension played a larger role. Patients with EF ≥55% had increased pulse pressure, suggesting a role for arterial stiffening. Treatment differed by EF. Creatinine increased ≥0.5 mg/dl more often in the group with HF and normal EF than in the group with HF and severely decreased EF. In-hospital mortality and length of stay in the intensive care unit varied inversely with EF; overall length of stay was similar. In conclusion, patients with HF and normal EF are more likely to be women, have a history of high pulse pressure hypertension, less coronary artery disease, and a lower risk of inpatient death but a higher likelihood of deterioration in renal function during hospitalization. These observations may be important considerations in the design of future clinical trials.
UR - http://www.scopus.com/inward/record.url?scp=41349112073&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2007.12.014
DO - 10.1016/j.amjcard.2007.12.014
M3 - Article
C2 - 18394450
AN - SCOPUS:41349112073
SN - 0002-9149
VL - 101
SP - 1151
EP - 1156
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 8
ER -