Abstract 14242: Hospital Treatment Practices and Long-Term Outcomes of Patients with Acute Heart Failure with Preserved and Reduced Ejection Fraction
Introduction: Few studies have examined the hospital treatment practices and long-term survival of patients with heart failure with preserved ejection fraction (HFPEF) and for those with reduced ejection fraction (HFREF), particularly from a population-based perspective. We hypothesized that medical treatment practices and long- term prognosis would be similar in these 2 groups.
Methods: The study sample consisted of 1,426 residents of the Worcester, MA, metropolitan area hospitalized at 11 greater Worcester medical centers for acute decompensated HF during 1995 and 2000. Patients were considered to have either normal (preserved HF) or reduced (reduced HF) ejection fraction (EF) results, using an EF cutpoint of 50%.
Results: In this population, 43% had HFPEF. Patients with HFPEF were older, were more likely to be female and diabetic, and presented with higher systolic blood pressure and body mass index at the time of hospitalization in comparison to patients with HFREF. Patients with HFREF were significantly more likely to be treated with disease-modifying cardiac medications (e.g., beta blockers, ACE- inhibitors, etc.) during hospitalization than patients with HFPEF with similar trends noted during each of the years under study. Similar hospital (5.4% vs 6.1%), 1 year (36.4% vs 37.6%) and 5 year (74.2% vs 76%) long-term death rates were observed in patients with HFPEF and HFREF with no differences noted during the 2 years under study. While significant beneficial effects of both β-blockers (HR=0.75; 95% CI 0.63,0.90) and ACE-inhibitors (HR=0.76; 95% CI 0.64,0.91) on post-discharge mortality were observed in patients with HFREF, a significant reduction in long-term mortality was observed only with β-blockers (HR=0.77; 95% CI 0.58,0.97) in patients with HFPEF.
Conclusions: In the acute setting, treatment practices may contribute to the long-term prognosis associated with decompensated HF, irrespective of type of acute HF. Beta blockers appear to provide a particular survival benefit for patients with decompensated HF.
- © 2011 by American Heart Association, Inc.