Trends in Patients Hospitalized with Heart Failure and Preserved Left Ventricular Ejection Fraction - Prevalence, Therapies, and Outcomes.
Circulation. 2012 May 21;
Authors: Steinberg BA, Zhao X, Heidenreich PA, Peterson ED, Bhatt DL, Cannon CP, Hernandez AF, Fonarow GC
BACKGROUND: Heart failure and preserved ejection fraction is a common syndrome, but trends in treatments and outcomes are lacking. METHODS AND RESULTS: We analyzed data from 275 hospitals in Get With The Guidelines Heart Failure from January, 2005 to October, 2010. Patients were stratified by ejection fraction as reduced (EF <40% [HF-reduced EF]), borderline EF (40%?EF<50% [HF-borderline EF]), or preserved (EF ?50% [HF-preserved EF]). Using multivariable models, trends in therapies and outcomes were examined. Among 110,621 patients, 50% (55,083) had HF-reduced EF; 14% (15,184) had HF-borderline EF; and 36% (40,354) had HF-preserved EF. From 2005 to 2010, the proportion of hospitalizations for HF-preserved EF increased from 33% to 39% (p<0.0001). In multivariable analyses, use of ACE-I/ARBs at discharge decreased in all EF groups; beta-blocker use increased. Patients with HF-preserved EF less frequently achieved blood pressure control (adjusted OR 0.44 vs. HF-reduced EF, p<0.001) and were more likely discharged to skilled nursing (adjusted OR 1.16 vs. HF-reduced EF, p<0.001). In-hospital mortality for HF-preserved EF decreased from 3.32% in 2005 to 2.35% in 2010, (adjusted OR 0.89 per year, p=0.01), but was stable for patients with HF-reduced EF (3.03% to 2.83%, adjusted OR 0.93 per year, p=0.10). CONCLUSIONS: Hospitalization for HF-preserved EF is increasing relative to HF-reduced EF. While in-hospital mortality for patients with HF-preserved EF declined over the study period, there remains an important opportunity for identification of evidence-based therapies in patients with HF-preserved EF.
PMID: 22615345 [PubMed - as supplied by publisher]