Abstract 830: Comorbidities Differentially Affect Symptoms in Heart Failure With Reduced vs. Preserved Ejection Fraction
Background: The prevalence of heart failure (HF) and preserved ejection fraction (HFPEF) is increasing. Co-morbidities largely contribute to morbidity and mortality in HF with reduced ejection fraction (HFREF), but their impact on symptoms and complications is much less analysed in patients with HFPEF.
Methods: Patients with HF were prospectively included into the multicenter German Competence Network on Heart Failure. A comprehensive common baseline data set was obtained. Patients were classified as having HFREF or HFPEF by echocardiographically determined LVEF with a cut-off of 50%. All values are given as mean (±SD) or as odds ratio (OR, 95% confidence interval). The relationship between NYHA-class and co-morbidities were analysed by ordinal regression analysis controlled for age, sex and LVEF.
Results: n=4079: age 64±13 years; n=1405 female; HFREF n=2785; HFPEF n=1294; NYHA I n=451, NYHA II n= 2233, NYHA III n=1302, NYHA IV n=93. Co-morbidities: 67% hypertension (HT), 58% hyperlipidemia (HLP), 43% coronary artery disease (CAD), 33% hyperuricemia (HU), 29% diabetes mellitus (DM), 32% renal failure (RF), 20% anaemia (AN), 30% obesity (OB). Patients with HFREF were in higher NYHA-classes (OR 2.89, 2.37–3.54). The presence of DM (OR 1.26; 1.11–1.45), RF (OR 1.51; 1.31–1.73) or AN (OR 1.77; 1.51–2.07) were significantly associated with higher NYHA class, at comparable extend in HFPEF and HFREF. CAD was also related to more severe dyspnoea in both groups, but with different (p=0.001) ORs: 1.17 (1.04 –1.32) for HFREF and 1.70 (1.38 –2.08) for HFPEF. We found significant relationships of NYHA to OB (1.38, 1.14 –1.66) and HT (1.25, 1.00 –1.56) only in the HFPEF group (p=0.012 and 0.050, respectively, for different ORs in HFPEF and HFREF). The impact of HLP on NYHA-class was opposing (p<0.001) between HFREF with an OR of 0.85 (0.75– 0.95) and HFPEF: OR 1.41 (1.18 –1.70).
Conclusion: Patients with HFREF were more symptomatic than with HFPEF. However, several typical co-morbidities in heart failure patients differentially affect symptoms in HFREF and HFPEF. This has to be considered in the evaluation and treatment of these patients.