Prevalence, Characteristics, Management, And Outcomes Of Hospitalized Patients With Heart Failure And Reduced Versus Preserved Ejection Fraction

OBJECTIVES To compare the clinical characteristics, management, treatment costs,and outcomes in patients hospitalized for heart failure with reduced versus preserved ejection fraction(EF).METHODS The patients admitted to the department of cardiology in our hospital with a discharge diagnosis of heart failure were studied retrospectively during the peroid of January 1, 2009 to October 31, 2009.The patient were finally included if they were aged 18 years or older, had NYHA classâ…¡-â…£, and met the 2008 Europe Society of Cardiology diagnostic criteria for heart failure.They were categorized into the follwing two groups: those with left ventrivular ejection fraction(EF) of less than or equal to 45 percent (heart failure with reduced ejection fraction group, HFREF group), and those with EF of more than 45 percent (heart failure with preserved ejection fraction group, HFPEF group).RESULTS There were 830 cases met the diagnostic criteria were recruited in the study.The prevalence of HFPEF and HFREF was 81.8% and 18.2% respectively. Compared with HFPEF group, HFREF group were more likely to be males, to have coronary heart disease and atrial fibrillation, but less likely to have hypertension (p<0.05). The average QRS duration was significantly longer in HFREF group than that in HFPEF group (p<0.001).The E/A value, left ventricle end-diastolic dimension and end-systolic dimension were higher in HFREF (p<0.001),while left ventricular posterior wall and interventricular septum were thicker in HFPEF(p<0.01). After adjusting for age, serum creatinine, white blood cell count and neutrophil count, uric acid remained significantly higher in HFREF group than that in HFPEF group (p=0.004).Whether with pneumonia or not, the white blood cell count, neutrophil count and neutrophil percentage were higher in HFREF group than those in HFPEF group (p<0.01), while lymphocyte count and lymphocytic percentage were lower in HFREF group (p<0.05). After adjusting for gender, red blood cell count, hemoglobin and hematocrit,red cell distribution width (RDW) remained significantly higher in HFREF group (p<0.01). The level of albuminuria was higher in HFREF group. Of the 183 patients who were assessed by N-terminal B-type natriuretic peptide (NT-proBNP) assay, 56 (30.6%) had preserved ejection fraction, whereas 127 (69.4%) had reduced ejection fraction. Patients with preserved ejection fraction had significantly lower NT-proBNP concentrations than those with reduced ejection fraction (p<0.001). Furthermore,the levels of NT-proBNP were increased as the severity of heart failure worsened by New York Heart Association class.Compared with HFPEF group, HFREF group received more ACEIs/ARBs, diuretics, spironolactone and digoxin (p<0.01), but less calcium channel blockers (p<0.001). Although length of hospital stay was the same in both groups (p=0.113), after excluding the dead ones, length of hospital stay was longer in HFREF (p<0.05). The treatment costs were lower in HFPEF group (p<0.05). In-hospital mortality was lower in HFPEF group when compared to HFREF group (3.31% vs 0.44%, p=0.005).CONCLUSIONS Our study shows a high prevalence of heart failure with preserved ejection fraction.Prognostic factors in heart failure, such as albuminuria, white blood cell count, RDW, uric acid, and NT-proBNP are significantly higher in HFREF than HFPEF. The treatment costs and in-hospital mortality are lower in HFPEF.