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Heart failure and cardiomyopathies
Original research article
Outcomes of de novo and acute decompensated heart failure patients according to ejection fraction
  1. Ki Hong Choi1,
  2. Ga Yeon Lee1,
  3. Jin-Oh Choi1,
  4. Eun-Seok Jeon1,
  5. Hae-Young Lee2,
  6. Hyun-Jai Cho2,
  7. Sang Eun Lee3,
  8. Min-Seok Kim3,
  9. Jae-Joong Kim3,
  10. Kyung-Kuk Hwang4,
  11. Shung Chull Chae5,
  12. Sang Hong Baek6,
  13. Seok-Min Kang7,
  14. Dong-Ju Choi8,
  15. Byung-Su Yoo9,
  16. Kye Hun Kim10,
  17. Hyun-Young Park11,
  18. Myeong-Chan Cho4,
  19. Byung-Hee Oh2
  1. 1 Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
  2. 2 Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  3. 3 Division of Cardiology, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  4. 4 Division of Cardiology, Department of Medicine, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea
  5. 5 Division of Cardiology, Department of Medicine, Kyungpook National University College of Medicine, Daegu, Korea
  6. 6 Division of Cardiology, Department of Medicine, The Catholic University of Korea, Seoul, Korea
  7. 7 Division of Cardiology, Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
  8. 8 Division of Cardiology, Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
  9. 9 Division of Cardiology, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
  10. 10 Division of Cardiology, Department of Medicine, Heart Research Center of Chonnam National University, Gwangju, Jeollanam-do, Korea
  11. 11 National Institute of Health (NIH), Osong, Korea
  1. Correspondence to Eun-Seok Jeon, Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea; esjeon{at}skku.edu

Abstract

Objective There are conflicting results among previous studies regarding the prognosis of heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF). This study aimed to compare the outcomes of patients with de novo acute heart failure (AHF) or acute decompensated HF (ADHF) according to HFpEF (EF≥50%), or HFrEF (EF<40%) and to define the prognosis of patients with HF with mid-range EF (HFmrEF, 40≤EF<50%).

Methods Between March 2011 and February 2014, 5625 consecutive patients with AHF were recruited from 10 university hospitals. A total of 5414 (96.2%) patients with EF data were enrolled, which consisted of 2867 (53.0%) patients with de novo and 2547 (47.0%) with ADHF. Each of the enrolled group was stratified by EF.

Results In de novo, all-cause death rates were not significantly different between HFpEF and HFrEF (HFpEF vs HFrEF, 206/744 (27.7%) vs 438/1631 (26.9%), HRadj 1.15, 95% CI 0.96 to 1.38, p=0.14). However, among patients with ADHF, HFrEF had a significantly higher mortality rate compared with HFpEF (HFpEF vs HFrEF, 245/613 (40.0%) vs 694/1551 (44.7%), HRadj 1.25, 95% CI 1.06 to 1.47, p=0.007). Also, in ADHF, HFmrEF was associated with a significantly lower mortality rate within 1 year compared with HFrEF (HFmrEF vs HFrEF, 88/383 (23.0%) vs 430/1551 (27.7%), HRadj 1.31, 95% CI 1.03 to 1.65, p=0.03), but a significantly higher mortality rate after 1 year compared with HFpEF (HFmrEF vs HFpEF, 83/295 (28.1%) vs 101/469 (21.5%), HRadj 0.70, 95% CI 0.52 to 0.96, p=0.02).

Conclusions HFpEF may indicate a better prognosis compared with HFrEF in ADHF, but not in de novo AHF. For patients with ADHF, the prognosis associated with HFmrEF was similar to that of HFpEF within the first year following hospitalisation and similar to HFrEF 1  year after hospitalisation.

  • Heart failure with preserved ejection fraction
  • Heart failure with reduced ejection fraction
  • Echocardiography
  • Heart disease
  • Epidemiology

https://doi.org/10.1136/heartjnl-2017-311813

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    Footnotes

    • Contributors KHC and E-SJ had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. B-HO, E-SJ: conceived and designed the research. B-HO, M-CC, H-YP. KHK, B-SY, D-JC, S-MK, SHB, SCC, K-KH, J-JK, H-YL, E-SJ: acquisition, analysis or interpretation of data. KHC, E-SJ: drafting of the manuscript. SEL, H-JC, GYL, J-OC made critical revision of the manuscript for key intellectual content. KHC, GYL: statistical analysis. B-HO: obtaining funding.

    • Funding This work was supported by Research of Korea Centers for Disease Control and Prevention [2010-E63003-00, 2011-E63002- 00, 2012-E63005-00, 2013-E63003-00, 2013-E63003-01, 2013- E63003-02, and 2016-ER6303-00].

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval This study was approved by the local institutional review board at each hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.