Abstract 3894: Clinical Presentation and Predictors of In-hospital Mortality in Acute Heart Failure Patients With Preserved Left Ventricular Ejection Fraction: The ALARM Registry
We sought to investigate the clinical presentation and in-hospital mortality of acute HF (AHF) cases with preserved left ventricular ejection fraction (PLVEF) in a large, international registry, the ALARM-HF.
Methods: The ALARM-HF was a retrospective in-hospital observational survey included 4.953 patients admitted for AHF to Cardiology Departments (67%) and Intensive Care Units (33%) in 6 European countries, Mexico and Australia. PLVEF was defined by a LVEF ≥45%.
Results: PLVEF patients represented 25% of the total cohort. Compared to patients with reduced LVEF, those with PLVEF were more frequently female (51% vs 30%, p<0.001), had more frequently de novo HF instead of acute exacerbation of chronic HF (45% vs 36%, p<0.001), but less frequently acute coronary syndromes (ACS) as the cause of AHF (24% vs 38%, p<0.001). Moreover, PLVEF patients had lower prevalence of cardiogenic shock (6% vs 13%), but higher prevalences of hypertensive HF (14% vs 5%) and right HF (8% vs 4%, overall p<0.001). On admission, PLVEF cases had significantly better NYHA class (class IV, 29% vs 41%, p<0.001) and higher systolic blood pressure (146±42 vs 129±38 mmHg, p<0.001), as well as less frequently elevated troponin (22% vs 36%, p<0.001) levels. Renal dysfunction and hyponatremia were also significantly less frequent in PLVEF patients (26% vs 30%, p=0.023 and 4% vs 6%, p=0.046). In-hospital mortality was significantly lower in the PLVEF group (7% vs 11%, p=0.013). Variables independently associated with in-hospital mortality included the presence of ACS (ACS, RR=3.835, p<0.001), low systolic blood pressure (RR=0.986, p=0.003) and serum creatinine levels (>1.5 versus ≤1.5 mg/dL, RR=2.024, p=0.029) at admission, a secondary versus a primary HF diagnosis (RR=0.512, p=0.040), a past history of cerebrovascular events (RR=4.736, p=0.020) and previous diuretic (RR=0.094, p=0.020) and ACE inhibitor (RR=0.217, p=0.037) therapy. AHF patients with PLVEF in the ALARM-HF had a different clinical profile and lower in-hospital mortality than those with reduced LVEF. The presence of ACS, low blood pressure and impaired renal function at admission, as well as the previous cardiovascular and drug therapy history were independent predictors of in-hospital mortality in these patients.