Thromboembolisms in atrial fibrillation and heart failure patients with a preserved ejection fraction (HFpEF) compared to those with a reduced ejection fraction (HFrEF)

2017 ◽  
Vol 33 (4) ◽  
pp. 403-412 ◽  
Author(s):  
Yoshihiro Sobue ◽  
Eiichi Watanabe ◽  
Gregory Y. H. Lip ◽  
Masayuki Koshikawa ◽  
Tomohide Ichikawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients

P6356Comparisons of clinical outcomes in patients with heart failure with preserved ejection fraction with and without atrial fibrillation: results from a multicenter PURSUIT-HFpEF registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Masuda ◽  
T Kanda ◽  
M Asai ◽  
T Mano ◽  
T Yamada ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients ◽  
Patients With Heart Failure

Abstract Background The presence of atrial fibrillation (AF) has been demonstrated to be associated with poor clinical outcomes in heart failure patients with reduced ejection fraction. Objective This study aimed to elucidate the impact of the presence of atrial fibrillation (AF) on the clinical characteristics, therapeutics, and outcomes in patients with heart failure and preserved ejection fraction (HFpEF). Methods PURSUIT-HFpEF is a multicenter prospective observational study including patients hospitalized for acute heart failure with left ventricular ejection fraction of >50%. Patients with acute coronary syndrome or severe valvular disease were excluded. Results Of 486 HFpEF patients (age, 80.8±9.0 years old; male, 47%) from 24 cardiovascular centers, 199 (41%) had AF on admission. Patients with AF had lower systolic blood pressures (142±27 vs. 155±35mmHg, p<0.0001) and higher heart rates (91±29 vs. 82±26bpm, p<0.0001) than those without. There was no difference in the usage of inotropes or mechanical ventilation between the 2 groups. A higher quality of life score (EQ5D, 0.72±0.27 vs. 0.63±0.30, p=0.002) was observed at discharge in patients with than without AF. In addition, AF patients tended to demonstrate lower in-hospital mortality rates (0.5% vs. 2.4%, p=0.09) and shorter hospital stays (20.3±12.1 vs. 22.6±18.4 days, p=0.09) than those without. During a mean follow up of 360±111 days, mortality (14.1% vs. 15.3) and heart failure re-hospitalization rates (13.1% vs. 13.9%) were comparable between the 2 groups. Conclusion In contrast to heart failure patients with reduced ejection fraction, AF on admission was not associated with poor long-term clinical outcomes among HFpEF patients. Several in-hospital outcomes were better in patients with AF than in those without. Acknowledgement/Funding None

scholarly journals Association of admission and discharge anemia status with outcomes in patients hospitalized for acute decompensated heart failure: Differences between patients with preserved and reduced ejection fraction

2017 ◽  
Vol 8 (7) ◽  
pp. 606-614 ◽  
Author(s):  
Katsuya Kajimoto ◽  
Yuichiro Minami ◽  
Shigeru Otsubo ◽  
Naoki Sato
Keyword(s):  
Heart Failure ◽  
Confidence Interval ◽  
Ejection Fraction ◽  
Primary Endpoint ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Hazard Ratio ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients

Background: In acute decompensated heart failure patients with a preserved or reduced ejection fraction, the association of admission and discharge anemia status with outcomes remains unclear. Methods and results: Of the 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 4433 patients (2017 with a preserved and 2416 with a reduced ejection fraction) were examined to investigate associations among the anemia status at admission and discharge (no anemia, developed anemia, resolved anemia, or persistent anemia), a preserved or reduced ejection fraction and the primary endpoint (all-cause death and readmission for heart failure). In the preserved ejection fraction group, adjusted analysis showed that either developed or persistent anemia was associated with a significantly higher risk of the primary endpoint relative to no anemia (hazard ratio: 1.53; 95% confidence interval (CI): 1.11–2.11; p=0.009 and hazard ratio: 1.60; 95% CI: 1.26–2.04; p<0.001, respectively), but there was no association between resolved anemia and the primary endpoint (hazard ratio: 0.98; 95% CI: 0.67–1.45; p=0.937). In the reduced ejection fraction group, either developed or resolved anemia was associated with a tendency toward higher risk of the primary endpoint relative to no anemia (hazard ratio: 1.29; 95% CI: 0.95–1.62; p=0.089, and hazard ratio: 1.31; 95% CI: 0.96–1.77; p=0.085, respectively), while persistent anemia was associated with a significantly higher risk of the primary endpoint relative to no anemia (hazard ratio: 1.36; 95% CI: 1.12–1.65; p=0.002). Conclusions: In acute decompensated heart failure patients, the association of admission and discharge anemia status with outcomes differs markedly between patients with a preserved or reduced ejection fraction.

scholarly journals Towards tailoring blood pressure control in HFpEF: Lessons from OPTIMIZE-HF

2019 ◽  
Vol 2019 (1) ◽  
Author(s):  
Mohamed Hassan
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Clinical Trial ◽  
Ejection Fraction ◽  
Observational Studies ◽  
Pressure Control ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Over Time

[first paragraph of article]Heart failure (HF) with preserved ejection fraction (HFpEF) represents approximately 50% of the world's HF population, and this proportion is increasing over time. The diagnosis of HFpEF is more challenging than HF with reduced ejection fraction (HFrEF). Patients with HFpEF are significantly older, more likely to be female, and more likely to have hypertension, obesity, anemia, atrial fibrillation, renal disease, and pulmonary disease compared to those with HFrEF. In observational studies, rates of hospitalization and death among patients with HFpEF approach those with HFrEF, however in clinical trial populations, outcomes are better in patients who have HFpEF. Death from non- cardiovascular causes is more common in patients who have HFpEF than in those with HFrEF, and a smaller percentage of patients with HFpEF die from CVD-related causes.

Abstract 17148: Association of Atrial Fibrillation With Short-Term Outcomes in Patients Hospitalized for Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Srikanth Yandrapalli ◽  
Amole Ojo ◽  
Prakash Harikrishnan ◽  
Venkat L Vuddanda ◽  
Mohammed Karim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Primary Outcome ◽  
The United States ◽  
Hospital Death ◽  
Preserved Ejection Fraction ◽  
Short Term ◽  
Reduced Ejection Fraction ◽  
Logistic Regression Models

Background: Atrial fibrillation (AF) is frequently present in patients with heart failure (HF) with preserved ejection fraction (HFpEF). The association of AF with short term outcomes in patients hospitalized for HFpEF is not well studied. Methods: We queried the United States Nationwide Readmissions Database year 2014 using appropriate ICD-9 codes to identify a weighted sample of adult patients hospitalized for HFpEF. Patients with concomitant diagnoses of HF with reduced ejection fraction (HFrEF) were excluded. The primary outcome was a composite of in-hospital death or a 30-day readmission for HF. Secondary outcomes studied were individual outcomes along with composites of in-hospital death or a 30-day readmission for any cause or cardiac etiologies. Survey specific adjusted multivariable logistic regression models were used to analyze the association of AF with outcomes. Results: Of 229,098 patients (mean age 76 years, 38% men) who were hospitalized for HFpEF during the study period, AF was present in 45.3% (N=103,852). Patients with AF were older (mean age 80 vs 72 years, p<.001) and more likely men (39% vs 37.5%, p<.001) compared to patients without AF. Primary outcome occurred in 9.5% patients with AF and in 8.0% patients without AF (p<0.001). After adjusting for patient demographics, comorbidities, complications, and hospital characteristics, AF was associated with 17% higher odds of the primary outcome (OR 1.17, 95% CI 1.11-1.23), 20% higher odds of in-hospital death (OR 1.20, 95% CI 1.07-1.34), and 17% higher odds of a 30-day readmission for HF (OR 1.17, 95% CI 1.10-1.25). Similar results were noted for other outcomes; TABLE . Conclusion: AF was associated with significantly worse short-term outcomes in patients hospitalized for HFpEF. Additional strategies are needed to improve outcomes in HFpEF patients with AF. Future prospective studies need to examine if AF ablation in HFpEF may improve outcomes as in HFrEF.

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