Abstract 14213: Predictors of Heart Failure Related Death or Hospitalization in Patients with Heart Failure due to Preserved Ejection Fraction

Abstract

Introduction: Heart failure with preserved ejection fraction (HFPEF) is increasingly being recognized as a major cause of cardiovascular morbidity and mortality. Specific therapeutic options for managing patients with HFPEF are lacking and treatment is focused on managing comorbidities. Given these limitations, an ability to identify patients at increased risk for adverse outcome can facilitate more careful and aggressive management of patients with HFPEF.

Methods: We performed subgroup analyses on patients with HFPEF on data from the Heart failure Adherence and Retention Trial (HART). HART enrolled patients who had been recently hospitalized for heart failure and evaluated the impact of self-management counseling versus education alone on composite primary outcome of subsequent heart failure hospitalization or mortality. A total of 208 patients with HFPEF enrolled in HART. Baseline data were collected on socio-demographics, medical and psychosocial factors, and adherence to prescribed medications. The patients were followed for a median of 1094 days. Odds ratios (OR) were estimated with respect to 22 key dichotomous variables and psychosocial factors were analyzed on a continuous scale.

Results: There was no significant effect of self-management counseling versus education alone on the primary outcome. However, a significant likelihood of primary event occurred in: males (OR 2.63;p=0.002), diabetics (OR 2.03,p=0.01), patients with stage 4 chronic kidney disease (OR 2.70,p=0.02), NYHA class III (versus class II) (OR 3.47,p=0.0001), 6 minute walk distance of < 620 feet (OR 2.22,p= 0.01), <80% adherence to prescribed medications (OR 2.15,p=0.02) and lower score on quality of life indices - physical functioning (p=0.03),and, energy and vitality (p=0.02). Psychosocial factors did not predict increased likelihood of primary outcome.

Conclusion: Patients with HFPEF who are male, diabetic, have NYHA class III symptoms, unable to walk >620 feet in 6 minutes, stage 4 or worse chronic kidney disease and non-adherent to prescribed medications are at an increased risk for heart failure hospitalization or death. These patients have limited functional capacity, need close monitoring and may benefit from aggressive management of comorbidities.