Abstract 14532: Contemporary Rates and Predictors of Hospitalization and Death in Heart Failure with Preserved Systolic Function
Background. Heart failure (HF) is a major and growing clinical and public health problem nationally and internationally. However, few contemporary data exist about the rates and predictors of adverse events in the expanding subgroup of patients with HF and preserved left ventricular systolic function (HFpSF), defined as left ventricular ejection fraction >=50%.
Methods. Among 4 participating health plans in the Cardiovascular Research Network (CVRN) PRESERVE Study, we identified all adult members with HFpSF between 2005-2008 based on validated ICD-9 codes from health plan hospital discharge and outpatient visit databases, along with results of left ventricular systolic function testing from electronic data sources and manual review. Baseline covariates were ascertained using validated algorithms from sites' clinical, administrative, laboratory, and pharmacy databases. Outcomes through December 2008 included (1) HF hospitalization using ICD-9 codes found in hospital discharge and billing claims databases and (2) death from any cause ascertained from health plan databases and state death files.
Results. Among 14,889 adults with confirmed HFpSF, mean age was 76±12 years, 58% were women, and 58% had prevalent HF. High rates (per 100 person-years) of HF hospitalization (22.1, 95% CI:21.6-22.7) and death (15.0, 95% CI:14.6-15.5) were observed. The strongest multivariable predictors of HF hospitalization included age >=85 yr (adjusted hazard ratio [HR] 1.6, 95% CI: 1.4-1.8); systolic blood pressure >=180 mmHg (3.1, 2.7-3.6) and 160-179 mmHg (1.8, 1.7-2.1); and hemoglobin 10-10.9 g/L (HR 2.6, 2.3-2.9), 9-9.9 g/L (HR 3.6, 3.2-4.0) and <9 g/L (HR 6.2, 5.4-7.3). The strongest multivariable predictors of death included age 75-84 yr (HR 2.1, 1.8-2.4); age >=85 yr (HR 3.4, 2.9-4.0); dementia (HR 1.9, 1.8-2.1); and hemoglobin 10-10.9 g/L (HR 3.2, 2.8-3.6), 9-9.9 g/L (HR 5.1, 4.5-5.8) and <9 g/L (10.1, 8.6-11.8).
Conclusions. Contemporary rates of HF hospitalization and death are high in HFpSF. Older age, uncontrolled hypertension, dementia and reduced hemoglobin level were the strongest independent predictors of adverse events and can identify high-risk HF patients for future interventional trials and targeting risk reduction strategies.
- © 2011 by American Heart Association, Inc.