Clinical investigations: congestive heart failureIncident cases of heart failure in a community cohort: importance and outcomes of patients with preserved systolic function☆
Section snippets
Identification of study cohort
The cohort that provides the basis for this study was designed to evaluate the hypothesis that cardiology specialty care provided early in the course of heart failure has a favorable effect on the treatment and outcomes of outpatients with new-onset heart failure.10 This was a retrospectively identified cohort study of patients with new-onset heart failure in the outpatient setting in the Northern California Kaiser Permanente system between July 1996 and August 1997. The Kaiser program was
Baseline characteristics
A total of 403 patients were identified with the chart review. Sixty-five patients (16%) did not undergo an assessment of LV function. Of the remaining 338 patients, 191 (57%) had an EF <45% (Low EF group) and 147 (44%) had preserved LV function (PrEF group). The patients’ baseline characteristics are shown in Table I. The average EF in the Low EF group was 31% ± 8%, and in the PrEF group, it was 56% ± 11%. The PrEF group was older (69 ± 11 vs 66 ± 11 years, P = .0124) and included more women
Discussion
In this unique cohort of patients with new-onset heart failure in the outpatient setting, approximately half (44%) of the patients had preserved LV function. This proportion is quite similar to that in recent reports from hospitalized cohorts and epidemiological studies,4, 6, 12 which confirm the importance of this group regardless of the clinical setting and presentation.
Patients with preserved systolic function tended to be older, more frequently women, have less coronary disease and
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Cited by (28)
Echocardiographic left ventricular end-diastolic pressure volume loop estimate predicts survival in congestive heart failure
2013, Journal of Cardiac FailureCitation Excerpt :Our data support the notion that diastolic function and systolic function may be evaluated separately and that correct classification of both may facilitate understanding of underlying pathophysiology. It is a relatively recent revelation that CHF with normal LVEF is highly prevalent and carries a serious prognosis at least rivaling those with depressed LVEF.37–44 To date, treatment trials in this population have yielded disappointing results.45
Diastolic dysfunction and heart failure with a preserved ejection fraction: Relevance in critical illness and anaesthesia
2012, Journal of the Saudi Heart AssociationCitation Excerpt :These include age, New York Heart Association Class IV symptoms, CAD, Diabetes, peripheral vascular disease and the presence of valvular heart disease. Whether patients survive longer after a diagnosis of systolic HF than a diagnosis of systolic HF is still debated [104–109] (Table 2). Hospital readmission rates and length of hospital stay for patients with HFpreEF are similar to SHF and the former have a higher likelihood of functional limitations or labile symptoms on follow-up [110,111].
Clinical characteristics and predictors of in-hospital mortality in acute heart failure with preserved left ventricular ejection fraction
2011, American Journal of CardiologyCitation Excerpt :For important predictors of survival such as SBP (relevant quartiles) and serum creatinine and troponin levels, Kaplan-Meier plots were constructed and are displayed in Figures 1, 2, and 3, respectively. Data from the ALARM-HF survey confirm findings of previous smaller studies and larger databases and provide new insights into patients with AHF and PLVEF.1,8–10,12,20 This analysis of the ALARM-HF database involved 837 patient episodes of AHF with PLVEF, which represents 25% of all HF hospitalizations with documented LVEF.
Characteristics, Treatments, and Outcomes of Patients With Preserved Systolic Function Hospitalized for Heart Failure. A Report From the OPTIMIZE-HF Registry
2007, Journal of the American College of CardiologyCitation Excerpt :Given the high post-discharge clinical event rate and the lack of proven effective therapies for this condition, there is a clear need to test treatment strategies for patients with HF and PSF in randomized clinical trials. Although these OPTIMIZE-HF data are consistent with earlier observations in patients with PSF, it should be noted that the OPTIMIZE-HF registry involved a much larger and more diverse group of patients than the majority of earlier reports (3–6,19,20,23,24). With the added contribution of early post-discharge outcomes, these data may be valuable in designing the prospective randomized trials that are much needed to identify agents to reduce risk and improve outcomes in patients with HF and PSF.
Are there sex-related differences in specialized, multidisciplinary congestive heart failure clinics?
2007, Canadian Journal of Cardiology
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Supported by a grant-in-aid from the California Affiliate of the American Heart Association and by a Health Services Research and Development Grant from the Department of Veterans Affairs. Dr Ansari was a recipient of an ACC Merck Fellowship, an Associate Investigator Award from the Department of Veterans Affairs, and an NHRSA award from the National Heart Lung and Blood Institute.