Trends in Patients Hospitalized with Heart Failure and Preserved Left Ventricular Ejection Fraction - Prevalence, Therapies, and Outcomes
Background—Heart failure and preserved ejection fraction is a common syndrome, but trends in treatments and outcomes are lacking.
Methods and Results—We analyzed data from 275 hospitals in Get With The Guidelines Heart Failure from January, 2005 to October, 2010. Patients were stratified by ejection fraction as reduced (EF <40% [HF-reduced EF]), borderline EF (40%≤EF<50% [HF-borderline EF]), or preserved (EF ≥50% [HF-preserved EF]). Using multivariable models, trends in therapies and outcomes were examined. Among 110,621 patients, 50% (55,083) had HF-reduced EF; 14% (15,184) had HF-borderline EF; and 36% (40,354) had HF-preserved EF. From 2005 to 2010, the proportion of hospitalizations for HF-preserved EF increased from 33% to 39% (p<0.0001). In multivariable analyses, use of ACE-I/ARBs at discharge decreased in all EF groups; beta-blocker use increased. Patients with HF-preserved EF less frequently achieved blood pressure control (adjusted OR 0.44 vs. HF-reduced EF, p<0.001) and were more likely discharged to skilled nursing (adjusted OR 1.16 vs. HF-reduced EF, p<0.001). In-hospital mortality for HF-preserved EF decreased from 3.32% in 2005 to 2.35% in 2010, (adjusted OR 0.89 per year, p=0.01), but was stable for patients with HF-reduced EF (3.03% to 2.83%, adjusted OR 0.93 per year, p=0.10).
Conclusions—Hospitalization for HF-preserved EF is increasing relative to HF-reduced EF. While in-hospital mortality for patients with HF-preserved EF declined over the study period, there remains an important opportunity for identification of evidence-based therapies in patients with HF-preserved EF.
- Received November 17, 2011.
- Accepted May 9, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited