Abstract 16703: Decompensated Heart Failure Patients with Preserved and Reduced Ejection Fraction who Require Ultrafiltration Therapy have Similar Morbidity and Mortality
Introduction: Ultrafiltration therapy (UF) has been increasingly used for acute decompensated heart failure (ADHF) patients who failed diuretic therapy. However little is known about the outcomes of UF in heart failure patients refractory to standard medical therapy with preserved ejection fraction (pEF). Hypothesis: Patients with pEF who require UF therapy experience morbidity and mortality similar to heart failure patients with reduced EF (rEF).
Method: We retrospectively studied 57 consecutive ADHF patients who required UF at University of Minnesota Medical Center from 2006 to 2011. All patients had a trial of loop diuretics. Selection of UF as the treatment method was made by the attending cardiologist. Subjects were divided into two groups: pEF (EF>0.45) and rEF (EF<0.45).
Results: Of a total of 57 patients, mean age was 67±14 years. Seventeen (30%) had pEF. Mean EF was 0.57±0.06 in the pEF group versus 0.25±0.11 in the rEF group (p <0.0001). Patients with pEF were more likely to be female compared to patients with rEF (p=0.02). Otherwise, characteristics including age, weight, right ventricular function and baseline creatinine (p=0.60) were equal in the two groups. During UF therapy, fluid removal rate, total fluid removal, documented weight lost and delta hematocrit were also similar (p=ns for all). At time of discharge, creatinine (p=0.07) was not different between patients with pEF and rEF. Similarly, 90-day readmission (53% vs. 51%, respectively, p=0.90) and mortality (40% vs. 43%, respectively, p=0.87) were comparable.
Conclusions: ADHF patients who are not responsive to conventional medical therapy have a high 90-day readmission rate and mortality despite improvement in weight and fluid removal with UF. Interestingly, these outcomes are similar among heart failure patients with pEF and rEF. Further studies are required to clarify the role of UF in patients refractory to conventional treatment since it is unlikely to change the natural history of ADHF.
- © 2012 by American Heart Association, Inc.