Analysis And Significance Of Clinical Characteristics Of Patients Hospitalized With Heart Failure In Different Ejection Fractions And Different Genders

Objective:Domestic and international guidelines have provided recommendations for the management of heart failure（HF）patients according to the variability between HF with different ejection fractions.Additionally,it has been reported that there are also differences in clinical characteristics between males and females with HF,as well as differences in sensitivity and effective dose of drugs,no treatment strategies have been proposed for the management of HF patients based on gender however.This study aimed to analyze the differences in clinical characteristics of HF patients with different ejection fractions and different genders and to reveal their clinical significance.Methods:Case information of patients discharged with a diagnosis including"heart failure"from January 1,2017 to December 31,2021 was collected by reviewing the HIS medical record system of Lanzhou University Second Hospital.A retrospective analysis was applied to first describe the general clinical characteristics of the included patients hospitalized with HF.Secondly,the differences in general clinical characteristics,laboratory tests,etiology and comorbidities,and clinical medications between HF patients with different ejection fractions and different genders were compared separately.Finally,the influencing factors of HF with reduced ejection fraction（HFrEF）and HF with preserved ejection fraction（HFp EF）were analyzed by establishing a binary logistic model,and the discriminant analysis functions of HFrEF and HFp EF were established.Results:1.General clinical characteristics of hospitalized HF patients:of the 5215patients hospitalized with HF（average age 65.0±15.1 years,56.0%male）,the average blood pressure at admission was（130.6±26.9/76.7±16.7）mm Hg,the average heart rate was（88.6±20.0）beats/min,the average hospital days was（10.7±9.4）days,11.0%were repeat admissions,including 2.1%readmissions within 30 days,1.8%died during hospitalization,and the proportion of New York Heart Association（NYHA）class III was the highest（66.7%）.The laboratory test results showed that the average alanine aminotransferase（ALT）was（85.3±347.9）U/L,the average aspartate aminotransferase（AST）was（98.6±514.2）U/L,the average uric acid（UA）was（429.4±171.9）umol/L,and the average D-dimer was（3.8±11.9）mg/L.The main causes were hypertension（43.2%）and coronary artery disease（CHD,23.6%）,and the main comorbidities were pulmonary infection（45.1%）,pleural effusion（26.7%）,atrial fibrillation（AF,22.2%）,renal insufficiency（20.5%）,type 2 diabetes mellitus（T2DM,18.8%）,and anemia（14.8%）.2.Comparison of clinical characteristics between HFrEF and HFp EF patients:HFp EF（67.2%）had the highest percentage,followed by HFrEF（21.4%）.Compared to HFrEF patients,HFp EF patients had average hemoglobin（Hb,122.3±36.2 vs137.1±27.8）,ALT（70.9±335.5 vs 131.8±448.3）,AST（76.6±397.3 vs 139.1±562.7）and UA（414.7±169.1 vs 457.2±168.9）were lower.They had lower rates of CHD（18.8%vs 38.3%）and dilated cardiomyopathy（DCM,0.8%vs 34.0%）,while had higher rates of hypertension（45.6%vs 29.3%）and rheumatic heart disease（1.1%vs 0.3%）,and comorbid pulmonary infections（51.9%vs 30.2%）,AF（22.5%vs 18.0%）,renal insufficiency（23.6%vs 12.5%）,T2DM（20.1%vs 14.2%）,anemia（19.0%vs 7.3%）,hypoproteinemia（11.0%vs 3.6%）,and electrolyte metabolism disorders（8.7%vs 4.7%）were higher（P<0.05）.3.Comparison of HF patients’clinical characteristics by gender:among all HF patients,compared with males,the average age were older（65.5±15.8 vs 64.6±14.6years）,diastolic blood pressure at admission（75.6±16.3 vs 77.5±17.1mm Hg）was lower,farmers（31.2%vs 27.0%）and other occupations（45.0%vs 38.1%）were higher,NYHA class III was higher（68.5%vs 65.3%）,elevated left ventricular end diastolic diameter（LVEDD,35.1%vs 38.6%）and left ventricular end systolic diameter（LVESD,37.2%vs 49.6%）were lower,and the proportion of HFp EF were higher（74.5%vs61.8%）in female patients.And the average Hb（118.9±31.4 vs 133.0±36.1）,ALT（57.8±207.2 vs 106.6±425.1）,AST（72.2±338.5 vs 119.2±616.7）and UA（410.2±171.4vs 444.4±170.1）were lower in females.They had higher rates of hypertension（45.9%vs 41.0%）and rheumatic heart disease（1.5%vs 0.5%）,lower rates of CHD（19.6%vs26.8%）and DCM（6.4%vs 11.5%）.They combined AF（25.1%vs 19.9%）and depressive states（0.6%vs 0.1%）were higher,and combined pleural effusion（24.8%vs 28.2%）was lower.In HFrEF patients,compared with males,Hb（125.0±25.0 vs142.6±27.2）,ALT（80.0±314.2 vs 155.4±495.8）and UA（415.8±153.0 vs 475.7±172.5）were lower in female patients,who had a lower proportion of CHD（30.8%vs 41.9%）and combined hyperuricemia（1.7%vs 6.1%）.In HFp EF patients,compared with males,Hb（116.1±32.5 vs 127.8±38.4）,ALT（49.9±146.5 vs 89.3±438.3）and UA（400.1±170.9vs 427.7±166.5）were lower in female patients,who had higher rates of valvular heart disease（6.5%vs 4.5%）and rheumatic heart disease（1.8%vs 0.6%）,comorbid AF（26.2%vs 19.2%）,hyperlipidemia（3.0%vs 1.3%）and depressive status（0.6%vs 0）were higher,and combined pulmonary infections（47.8%vs 55.6%）,pleural effusions（25.6%vs 31.3%）,renal insufficiency（21.6%vs 25.4%）and electrolyte metabolism disorders（7.3%vs 10.0%）were lower（P<0.05）.4.Use of therapeutic drugs during hospitalization:for all HF inpatients in this study,diuretics were the most used（88.9%）,followed by mineralocorticoid receptor antagonist（MRA,55.5%）,beta-blocker（BB,37.8%）,angiotensin conv-erse enzyme inhibitor/angiotensin II receptor blocker/angiotensin receptor/neprily-sin inhibitors（ACEI/ARB/ARNI,27.2%）,ARNI（16.0%）,the"triple therapy"（ACEI/ARB/ARNI+BB+MRA,13.7%）,sodium-glucose co-transporter 2 inhibitor-s（SGLT2i,2.4%）and the"quadruple therapy"（ACEI/ARB/ARNI+BB+MRA+SGLT2i,0.9%）.From 2017 to 2021,the utilization rates of ARNI,BB,SGLT2i and the"quadruple therapy"increased year by year,the utilization rate of ACEI/ARB/ARNI increased year by year from 2018,while the utilization rate of the"triple therapy"gradually increased during 2017-2020 and decreased in 2021,and there was no obvious trend in the utilization rate of MRA.5.Comparison of drug therapy use in HF patients with different ejection fractions and different genders:HFrEF patients were more likely to use all drugs than HFp EF（P<0.05）.No statistically significant difference between male and female therapeutic drug use in HFrEF patients（P>0.05）.In HFp EF patients,female patients were more likely to use ACEI/ARB/ARNI（21.6%vs 11.8%）,BB（36.6%vs 30.9%）and MRA（53.2%vs 48.0%）（P<0.05）.6.The results of the analysis of factors influencing HFrEF and HFp EF showed that systolic blood pressure（SBP,OR:1.032,95%CI:1.019-1.045）,PLT（OR:1.001,95%CI:1.000-1.002）and LVEDD（OR:1.120,95%CI:1.053-1.192）were influencing factors for HFp EF patients,that is,the higher the SBP,PLT and LVEDD,the easier it is to lead to HFp EF.DBP（OR:0.962,95%CI:0.945-0.979）,Hb（OR:0.993,95%CI:0.986-0.999）and LVESD（OR:0.695,95%CI:0.651-0.741）were predictors for HFrEF patients,that is,the higher the DBP,Hb and LVESD,the easier it is to lead to HFp EF（P<0.05）.7.The Fisher classification discriminant analysis function for HFrEF and HFp EF patients was established by incorporating 13 variables such as age（A）,SBP,DBP,heart rate（HR）and Hb into the discriminant analysis function: f₁（HFrEF）=-468.928+0.385*A+0.115*SBP-0.009*DBP+0.364*HR-0.040*Hb+0.013*PLT+0.011*ALT-0.006*AST+0.026*UA+6.460*Na⁺-0.374*Cl^-+0.956*TC;f₂（HFp EF）=-467.784+0.408*A+0.142*SBP-0.039*DBP+0.368*HR-0.051*Hb+0.014*PLT+0.011*ALT-0.006*AST+0.025*UA+6.490*Na⁺-0.435*Cl^-+0.935*TC.The indicators for each individual were substituted into the equation and the observations were classified to the value of the classification function with the larger discriminant function.The correct rate of the retrospective test was 67.7%and the correct rate of the crossover method test was 67.5%.Conclusions:1.HF patients hospitalized at Lanzhou University Second Hospital during the period from January 1,2017 to December 30,2021 were older and more male.They were sicker at admission,with a higher proportion of NYHA class III,and already had concurrent damage to multiple organ systems,including liver,kidney,and coagulation system.They had more HFp EF patients,the major etiologies of hypertension and CHD,and also had more comorbidities.2.There were differences between the clinical characteristics of HFrEF and HFp EF patients and corresponding differences in drug therapy.HFrEF patients had more severe liver impairment and higher UA.The main etiologies were CHD and DCM,and they had higher use of therapeutic drugs.HFp EF patients were older,more likely to be female,and they had fewer comorbidities.3.There were differences between the clinical characteristics of male and female patients,although there were no differences in medication use in HFrEF patients.Among all HF patients,male patients were mostly HFrEF with more severe liver impairment and higher UA.Female patients were older,less educated,and mostly HFp EF patients.4.Increased SBP,PLT and LVEDD predispose to HFp EF;Increased DBP,Hb and LVESD predispose to HFrEF.