Abstract 16306: Preserved Ejection Fraction and Patient Comorbidities in the Outpatient Clinics of the Canadian Heart Failure Network
While heart failure (HF) often presents with similar symptoms and signs, the etiology and accompanying comorbidities can be very different among patients. Although we have evidence based treatments for HF with reduced left ventricular ejection fraction (LVEF), we have few proven treatments for HF with preserved LVEF that alter the natural history of that syndrome. We wished to identify some of the differing co-morbidities and their prevalence in a large (n=11,496) consecutive cohort of ambulatory patients referred for specialized multidisciplinary management to the HF outpatient clinics of the Canadian Heart Failure Network (CHFN). 9,210 patients had a reduced LVEF <0.45 and 2,286 had a preserved LVEF >0.45. The LVEF <0.45 group, compared to the LVEF >0.45, showed the following differences: Male, 74.8% vs 54.9%, p<0.001; Age, 65.9 vs 68.6 yrs, p<0.001; LVEF, 0.26 vs 0.55, p<0.001; Yrs of HF, 2.56 vs 2.26 yrs p=0.006; History of hypertension, 43.5% vs 50.8% p<0.001; History of diabetes 29.8% (Type I, 1.5%; Type II diet, 21.1%; Type II insulin 7.2%) vs 28.6% (Type I, 0.7%; Type II diet, 18.3%, Type II insulin 9.7%) p<0.001; History of dyslipidemia, 43.3% vs 36.4%, p<0.001; History of renal dysfunction, 18.1% vs 21.5%, p<0.001; Number of CV co-morbidities, 3.52 vs 3.46, p=0.046; NYHA FC (1, 2, 3, 4) 11.7, 41.4, 43.1, 3.8% vs 18.1, 36.5, 41.8, 3.6%, p<0.001. There were no significant differences between reduced and preserved EF groups among five major ethnic groups. Ambulatory patients referred for specialized multidisciplinary care in these HF outpatient clinics, and differentiated by an LVEF cut point of 0.45, confirmed the prevalence of older age, a more prevalent history of hypertension and renal dysfunction, and the higher use of insulin to treat Type II diabetes. While age remains unmodifiable, earlier multidisciplinary clinical trials to intervene on multiple targets including hypertension, diabetes, and renal dysfunction are required and more integrated collaboration of disease specific clinics may provide better understanding and treatments for HF with LVEF >0.45.
- © 2011 by American Heart Association, Inc.