Ejection fraction often above 40% in advanced heart failure

Reuters Health - 26/08/2021 - More than half of advanced heart failure (HF) patients in a population-based study had mid-range or preserved ejection fraction (EF), and survival was poor regardless of EF, researchers say.

"We were surprised that 43% of patients with advanced HF had preserved ejection fraction (EF 50% or higher)," Dr. Shannon Dunlay of Mayo Clinic in Rochester, Minnesota told Reuters Health by email. "On average, prognosis was poor in patients with advanced HF who did not receive advanced HF therapies - i.e., LVAD or heart transplant. Only about half survived longer than a year."

"This information is helpful to clinicians for communicating with patients about prognosis and for recognizing the importance of identifying patients with advanced HF who may be eligible for LVAD or transplant early on, so they can be referred for consideration for these therapies," she said.

As reported in JACC: Heart Failure, Dr. Dunlay and colleagues identified 6,836 adults from Olmsted County, Minnesota with HF and applied the 2018 European Society of Cardiology advanced HF diagnostic criteria to all HF patients.

Analyses included hospitalization and mortality in advanced HF overall, and by EF type: reduced EF <40% (HFrEF); mid-range EF 40%-49% (HFmrEF); and preserved EF 50% or greater (HFpEF).

Overall, 936 patients (13.7%) met the criteria for advanced HF. The mean age was about 77. About 56% were men, and 94% were white.

The prevalence of advanced HF increased with age and was higher in men.

At advanced HF diagnosis, 42.3% of patients had HFrEF; 14.3% had HFmrEF; and 43.4% had HFpEF. The median time from advanced HF diagnosis to death was 12.2 months, and the mean rate of hospitalization was 2.91 per person-year in the first year after the diagnosis.

Risks of all-cause mortality or hospitalization did not differ by EF. However, patients with advanced HFpEF were at lower risk for cardiovascular mortality compared with advanced HFrEF (HR, 0.79).

Dr. Dunlay said her team's next research steps include "finding easier ways to identify patients with advanced HF using electronic health record data; understanding which patients with newly diagnosed HF are at highest risk for developing advanced HF; learning more about how to better care for patients with advanced HF; and understanding if optimizing use of guideline-directed medical therapy early on in patients with HF prevents the development of advanced HF."

In a related editorial, Dr. Maria Rosa Costanzo of Midwest Cardiovascular Institute in Naperville, Illinois and Dr. Joseph Rogers of Texas Heart Institute in Houston write, "The findings of this study...uncover the disconnect between the prevailing perception of AHF as a condition of young people with severely depressed EF who are candidates for more definitive treatments. Instead, the 'real' AHF in the community occurs primarily in elderly persons with preserved EF who experience recurrent hospitalizations triggered by disorders other than HF."

SOURCE: https://bit.ly/2WtD4QM and https://bit.ly/3kwuwRt JACC: Heart Failure, online August 11, 2021.

By Marilynn Larkin



Posted on 26 August 20212 September 2021