Abstract 3150: Ejection Fraction and Mortality in Elderly Patients Hospitalized With Heart Failure: Is Preserved Ejection Fraction Comparable to Reduced Ejection Fraction?
Background: Recent studies found patients with heart failure and preserved ejection fraction (EF, ≥50%) had comparable mortality to patients with reduced (<50%) EF. The generalizability of this finding to elderly patients is unknown.
Methods: Data from the National Heart Failure Project, a national sample of Medicare patients hospitalized with heart failure in 1998 –1999 and 2000 –2001, was used to assess the association of EF and 1-year mortality. Analysis was limited to patients 65 years and older admitted with a principal discharge diagnosis of heart failure for whom EF data were available (n=39,621). Patients were categorized as preserved EF (EF ≥50%), mild left ventricular systolic dysfunction (LVSD, EF 40%– 49%), moderate LVSD (EF 30%–39%), or severe LVSD (EF<30%). Logistic regression models with fractional polynomials for EF were used to assess the association of EF and 1-year mortality adjusting for patient, physician, and hospital characteristics.
Results: Median EF was 38%, with 37.9% of patients having preserved EF. Crude overall one year mortality was 35.6%, lowest among patients with preserved EF (29.9%) and increased with severity of LVSD (mild 33.2%, moderate 36.0%, severe 44.0%, P<0.001 for trend). Multivariable logistic regression models indicated any increase in severity of LVSD was associated with successive increases in risk of 1-year mortality (Figure 1⇓).
Conclusions: Heart failure with preserved EF is common among elderly patients. Although overall mortality is high in this population, patients with preserved EF have a lower relative mortality risk compared with patients with LVSD. Any reduction in EF is associated with increased 1-year mortality.