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
- Heart disease
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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.