Abstract 14681: Heart Failure with Preserved Ejection Fraction (hfpef): What are the Predictors of Poor Outcome?
Introduction Heart failure (HF) is a complex clinical syndrome with high morbidity and mortality. For those with left ventricular systolic dysfunction (LVSD) there are models to predict long term outcome. HF with preserved ejection fraction (HFPEF) is increasingly recognised in clinic practice, but factors that predict poor outcome are not known. Predictors of poor outcome cannot be extrapolated from patients with LVSD, as the natural history of LVSD and HFPEF is not comparable. In this nested cohort study we report the predictors of long-term outcome of patients with HFPEF.
Method Patients were referred from primary or secondary care to a diagnostic HF clinic. Based on the initial clinical assessment and echo, patients were allocated to one of 3 groups: HF due to LVSD, HFPEF & non-HF. HFPEF was diagnosed using the following criteria: ongoing NYHA class II-IV symptoms, preserved systolic function (EF > 45%) plus any two abnormal investigations 1) Chest X-ray showing pulmonary oedema or cardiomegaly, 2) echocardiogram with left ventricular hypertrophy, left atrial diameter >40 mm, or E/A ratio <0.5 & 3) ECG showing LBBB, LVH or atrial fibrillation(AF). Data were obtained from hospital & GP records, & mortality data from the death certificates.
Results From Jan 2002- Dec 2007, 1034 patients were referred. Of these 270 (26%) were diagnosed with LVSD & 242 (23%) fulfilled the diagnostic criteria for HFPEF. Non HF was diagnosed in 522. Average follow up was 5.5 yrs (3-8.5 yrs). Compared to LVSD, HFPEF patients were older, more likely to be female & were more likely to have hypertension, AF & diabetes. Mortality was high in both groups, LVSD 163(60%) & HFPEF 119(50%) (P=0.018). In Cox regression analysis of the HFPEF patients, age, NYHA class, weight and admission to hospital for any reason were highly significant. Whereas gender, history of diabetes(DM), ischemic heart disease(IHD), smoking or the use of ACE inhibitors, beta blockers were not significantly related to survival.
Conclusion Whereas patients with LVSD and HFPEF have similar long-term mortality, the predictors of outcome are quite different. Risk factors for LVSD like gender, IHD, DM, and smoking are not significantly related to survival in HFPEF. These data should inform future trials in patients with HFPEF.
- © 2012 by American Heart Association, Inc.