Abstract 11035: Worsening Renal Function in Hospitalized Heart Failure Patients with Preserved vs. Reduced Ejection Fraction
Introduction: Worsening renal function (WRF) during treatment of acute heart failure (AHF) has been associated with poor outcomes.
Hypothesis: As patients with heart failure and preserved ejection fraction (HFpEF) are older and may have more comorbidities than HF patients with reduced EF (HFrEF), we hypothesized that WRF would be more common, and associated with worse outcomes in patients with HFpEF compared to patients with HFrEF.
Methods: We examined the incidence and predictors of WRF (defined as increase in serum creatinine of ≥0.3 mg/dL over baseline), and associated outcomes in patients with HFpEF vs. HFrEF hospitalized with AHF, enrolled in the Diuretic Optimization Strategies Evaluation (DOSE) Trial.
Results: Of 300 patients hospitalized with AHF and enrolled in DOSE, 73% had HFrEF and 27% had HFpEF (EF≥50%). HFpEF patients were older (72±11 vs 64±14 yrs, p<0.0001), had lower eGFR (48±21 vs 57±25 ml/min/1.73m2, p=0.01), higher BMI (35±9 vs 33±12 kg/m2, p=0.02), higher systolic blood pressure (124±22 vs 117±19 mmHg, p=0.008), more frequent history of atrial fibrillation (69% vs 48%, p=0.0009), but a lower prevalence of ischemic heart disease (46% vs 63%, p=0.009) compared to HFrEF. By study design, all patients had been on outpatient diuretics at a daily dose equivalent of furosemide 80 to 240 mg. 33% of HFpEF and 25% of HFrEF patients (p=0.16) had WRF in hospital (24, 48, 96 hours or 7 days/discharge after enrollment), whereas 22% of HFpEF and 17% of HFrEF patients (p=0.3) had WRF at day 7/discharge. By multivariate analysis, factors at enrollment that were significantly associated with WRF at day 7/discharge included lower hemoglobin (p=0.02), history of gout (0.01), higher body mass index (p=0.01), lack of hepatomegaly (p=0.01) and lack of beta-blocker use (p=0.01); by interaction analysis these factors were not different in HFpEF vs HFrEF. Baseline Cystatin C was not an independent predictor of WRF. WRF was not associated with a greater risk of the combined endpoint of time to first rehospitalization, emergency room visit for intravenous diuretics or death (HR 1.1, 95% CI 0.7, 1.8).
Conclusions: Despite greater age and co-morbidities, there were no significant differences in the incidence and predictors of WRF in HFpEF compared to HFREF patients.
- © 2010 by American Heart Association, Inc.