Abstract 14239: Trends and Outcomes in Hospitalizations With Acute Diastolic Heart Failure, 2003 to 2012
Introduction: Hospitalizations for heart failure with preserved ejection fraction (HFpEF) are increasing. There is limited data examining contemporary trends and outcomes in patients hospitalized with HFpEF.
Hypothesis: Outcomes in patients hospitalized with HFpEF are improving over time.
Methods: We examined all hospitalizations with acute heart failure (n=5,829,546) in 2003-2012 using the Nationwide Inpatient Database. Based on ICD-9 codes, we identified 2,329,391 (~40%) as acute diastolic heart failure without concurrent systolic heart failure, or HFpEF. Patient characteristics, in-hospital mortality rates, and length of stay (LOS) were examined.
Results: Compared to those with heart failure with reduced ejection fraction (HFrEF), those with HFpEF were older (mean 76±13 vs 72±14 years), more likely female (64% vs 42%), and more likely to have hypertension (67% vs 64%), atrial fibrillation (43% vs 39%), chronic pulmonary disease (38% vs 32%), renal failure (36% vs 35%), and anemia (34% vs. 26%) (all p<0.001). Over time, HFpEF comprised increasing proportions of men and patients aged ≥75. Compared to HFrEF, in-hospital mortality rate was lower (4.3% vs 5.1%), and mean LOS was higher in HFpEF (7.0 vs 6.8 days) (both p<0.001). The in-hospital mortality rate for HFpEF declined by 13% from 2003 to 2012 (4.8% to 4.2%, p-for-trend <0.001), reflecting improved survival in females and those aged ≥65 years (both p-for-trend<0.01). Mean LOS declined by 8% (7.4 to 6.8 days, p-for-trend<0.001). Adjusting for potential confounders using multivariate regression analysis, pulmonary circulation disease (OR 1.90, 95%CI [1.86 to 1.94]), liver disease (OR 1.57, CI [1.52-1.63]), and renal failure (OR 1.35, CI [1.33-1.37]) were independent predictors of in-hospital mortality. Whereas atrial fibrillation (OR 1.07 [CI 1.06-1.08]) was mildly associated with in-hospital mortality, traditional factors of hypertension (OR 0.64 [CI 0.63-0.65]), diabetes (OR 0.77 [CI 0.76-0.78]), and CAD (OR 0.79 [CI 0.78-0.80]) were inversely related (all p<0.001).
Conclusions: Hospitalizations for HFpEF place a significant burden on the U.S. health care system. Our study, which represents the largest cohort of HFpEF to date, shows that outcomes have improved between 2003 and 2012.
Author Disclosures: P. Goyal: None. Z.I. Almarzooq: None. I. Sobol: None. M. Karas: None. H.S. Singh: None. R.V. Swaminathan: None. D.N. Feldman: None. R.M. Minutello: None. G. Bergman: None. S. Wong: None. E.M. Horn: None. L.K. Kim: None.
- © 2015 by American Heart Association, Inc.