Abstract 15844: Why Are patients With Heart Failure and Preserved Ejection Fraction Hospitalized? Data From I-PRESERVE
Background: Patients with heart failure and preserved ejection fraction (HFpEF) have an alarming rate of all-cause hospitalizations (ACH). Previous reports show that worsening HF (HF-Hospitalizations) is the primary cause in only a minority of ACH. However, there is no information on the cause of non-HF hospitalizations, either as the initial or as recurrent events.
Methods: We examined ACH in 4128 patients with HFpEF and LVEF ≥ 45% in the I-PRESERVE Trial that randomly assigned patients to irbesartan or placebo and followed them for a mean of 49 months. All hospitalizations were adjudicated by a committee using predefined and standardized definitions.
Results: A total of 2278 patients had 5863 ACH (Table). Overall 53.6% were classified as cardiovascular including 21.1% for HF-Hospitalizations 5.6% for cardiac procedures 3.7% for atrial dysrhythmias, 3.2% for stroke, 3.5% unstable angina, 4.3% for chest pain (3.6%) and 2.6% for myocardial infarction. Several other causes accounted for less than 2%. Hospitalizations for a specific non-CV cause were 43.7% of total. Of the 5863 ACH, 3585 (61%) were recurrent hospitalizations. The proportions of different causes for recurrent events were similar to the first hospitalizations although there was a trend for more recurrent HF-Hospitalizations (17.6% vs 23.3%).
Summary: Admissions for CV cause were the majority of hospitalizations, though admissions for non-CV causes were common. Among CV admissions, hospitalizations for HF were the largest single group while those for atrial dysrhythmias, cardiac ischemia, and cerebrovascular events were surprisingly infrequent.
Conclusion: These data illustrate the challenge of reducing hospitalizations in HF-PEF patients. Strategies to prevent both CV and non-CV hospitalizations must be developed. However, the largest single target remains prevention of hospitalization for HF.
- © 2013 by American Heart Association, Inc.