Weight loss early after discharge predicts the risk of rehospitalization in non-obese patients with heart failure preserved ejection fraction

Abstract Background Weight loss (WL) has been considered as a prognostic factor in heart failure with reduced ejection fraction (HFrEF). However, the prognosis and associated factors of WL in heart failure with preserved ejection fraction (HFpEF) have remained unclear. Purpose This study aimed to examine the prevalence, prognosis, and clinical characteristics of worse prognosis based on the identified WL after discharge in HFpEF. Methods The study was conducted as a part of a multicenter cohort study (Flagship). The cohort study enrolled ambulatory HF who hospitalized due to acute HF or exacerbation of chronic HF. Patients with severe cognitive, psychological disorders or readmitted within 6-month after discharge were excluded in the study. WL was defined as ≥5% weight loss in 6-month after discharge and HFpEF was defined as left ventricular ejection fraction (LVEF) ≥50% at discharge. Age, gender, etiology, prior HF hospitalization, New York Heart Association (NYHA) class, brain natriuretic peptide (BNP) or N-terminal-proBNP (NT-proBNP), anemia (hemoglobin; male <13g/dL, female <12g/dL), serum albumin, Geriatric Depression Scale, hand grip strength and comorbidities were collected at discharge. Patients were stratified according to their body mass index (BMI) at discharge as non-obese (BMI <25) or obese (BMI ≥25). We analyzed the association between WL and HF rehospitalization from 6 month to 2 years after discharge using Kaplan-Meier curve analysis and Cox regression analysis adjusted for age and gender, and clinical characteristics associated to worse prognosis in WL using logistic regression analysis adjusted for potential confounders in HFpEF. Results A total of 619 patients with HFpEF were included in the analysis. The prevalence of WL was 12.9% in 482 non-obese and 15.3% in 137 obese patients. During 2 years, 72 patients were readmitted for HF (non-obese: 48, obese: 24). WL in non-obese independently associated with poor prognosis (hazard ratio: 2.2: 95% confidence interval: 1.13–4.25) after adjustment for age and sex, while WL in obese patients did not. Logistic regression analysis chose age (odds ratio 1.02 per 1 year; 1.00–1.05), anemia (2.14; 1.32–3.48), and BNP ≥200pg/mL or NT-proBNP ≥900pg/mL (1.83; 1.18–2.86) as independent associated factors for worse prognosis of WL in non-obese patients. Conclusion In HFpEF, WL in early after discharge in non-obese elderly patients may be a prognostic indicator for HF rehospitalization. HF management including WL prevention along with controlling anemia is likely to improve prognosis in this population. Kaplan Meier survival curves Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): A Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science

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Abstract 13520: Sex Differences in Clinical Characteristics and Outcomes of Patients with Heart Failure with Preserved Ejection Fraction -A Report from the CHART-2 Study

Circulation ◽

10.1161/circ.130.suppl_2.13520 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Kanako Tsuji ◽

Yasuhiko Sakata ◽

Masanobu Miura ◽

Satoshi Miyata ◽

Kotaro Nochioka ◽

...

Keyword(s):

Heart Failure ◽

Sex Differences ◽

Ejection Fraction ◽

Clinical Characteristics ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Preserved Ejection Fraction ◽

Female Patients ◽

Kaplan Meier ◽

Patients With Heart Failure

Background: Several studies have reported that the prognosis of patients with heart failure with preserved ejection fraction (HFpEF) was similar to that of patients with reduced ejection fraction. However, sex differences in clinical characteristics and mortality of HFpEF patients remains to be fully elucidated. Methods: Among the 10,219 patients registered in our Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study, we examined sex differences in clinical characteristics, treatment and long-term outcome of 3,124 patients with HFpEF in stage C/D (EF≥50%, mean age 69.4 years, 34.7% female). We constructed the Kaplan-Meier curves and Cox hazard models for all-cause death to evaluate sex difference in mortality. Results: Female patients, as compared with male patients, were characterized by higher age (71.6 vs. 68.3 years, P<0.001), higher prevalence of NYHA class III/IV (14.1 vs. 7.0%, P<0.001), higher left ventricular ejection fraction (67.2 vs. 64.5%, P<0.001), and higher brain natriuretic peptide levels (106 vs. 72.9pg/ml, P<0.001). Furthermore, less female patients received beta-blockers (37.8 vs. 43.9%, P=0.001) and renin-angiotensin system inhibitors (64.7 vs. 71.8%, P<0.001) compared with males. During the median 3.2-year follow-up, 392 patients (12.5%) died. Although Kaplan-Meier curves showed that the crude mortality was comparable between males and females (hazard ratio (HR) 1.18, P=0.11), the adjusted mortality risk was significantly lower in females (HR 0.72, P=0.009) (Figure). Female patients died due to cardiovascular causes more frequently than males (53.7 vs. 39.2%, P<0.01). Conclusions: Although female HFpEF patients had comparable all-cause mortality with males, they had severer HF and higher cardiovascular mortality than males.

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The clinical characteristics of patients with arterial hypertension, symptoms of heart failure and preserved ejection fraction depending on E/e´ at rest and under physical exertion

Ukrainian Journal of Cardiology ◽

10.31928/1608-635x-2018.4.6474 ◽

2018 ◽

pp. 64-74

Author(s):

K.M. Amosova ◽

◽

O.V. Vasylenko ◽

K.P. Lazareva ◽

N.V. Shyshkina ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Arterial Hypertension ◽

Clinical Characteristics ◽

Physical Exertion ◽

Preserved Ejection Fraction

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Five-Year Outcomes of Heart Failure with Preserved Ejection Fraction

The Open Cardiovascular Medicine Journal ◽

10.2174/18741924020140100018 ◽

2020 ◽

Vol 14 (1) ◽

pp. 18-26

Author(s):

Cristina Macía-Rodríguez ◽

Emilio Páez-Guillán ◽

Vanesa Alende-Castro ◽

Alba García-Villafranca ◽

Lara Maria Mateo-Mosquera ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Clinical Characteristics ◽

Hypertensive Heart Disease ◽

Preserved Ejection Fraction ◽

Related Factors ◽

Factors Associated ◽

Heart Failure Unit ◽

High Level

Objective: The aim of this study was to describe the clinical characteristics of patients that have had a heart failure with preserved ejection fraction (HF-pEF) and to identify the factors associated with 5-year mortality and readmission. Methods: A prospective cohort study was conducted of patients followed by the Heart Failure Unit of the Internal Medicine Department. Clinical characteristics and outcomes were collected. Univariate and multivariate analyses were performed in order to identify factors associated with 5-year mortality and readmission. Results: A total of 209 patients with HF-pEF were followed, 59.3% of these were women, with a mean age 79 years. The main etiology was hypertensive heart disease and a high level of comorbidity (chronic renal failure, hypertension and atrial fibrillation) was observed. The 5-year mortality was 55.5%; the related variables were anemia (hazard ratio [HR]=1.7; 95% confidence interval [CI]: 1.2-2.5), in patients being treated with statins (HR=0.7; 95%CI 0.5-0.9) and spironolactone (HR= 1.6; 95% CI: 1.1-2.3); 24.5% of patients had >2 admission in 5 years, with the main related factors being atrial fibrillation (HR=2.7; 95%CI: 1.4-5.5), anemia (HR=1.9; 95%CI:1.0-3.3) and were being treated with spironolactone (HR=2.1; 95%CI:1.2-3.7). Conclusion: Patients with HF-pEF are old and present a high level of comorbidity. Furthermore, they have a high 5-year mortality and readmission rate. The only factor associated with lower mortality was the treatment with statins. The use of spironolactone was associated with a higher mortality risk.

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Heart Failure with Preserved Ejection Fraction in Morbidly Obese Patients is Associated with Increased Readmission Rate: Study from Large, Multicentric National Database

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2019.07.420 ◽

2019 ◽

Vol 25 (8) ◽

pp. S146

Author(s):

Moghniuddin Mohammed ◽

Ioannis Mastoris ◽

Juwairiya Arshi ◽

Habeeb A. Mohammed ◽

Andrew Sauer ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Readmission Rate ◽

National Database ◽

Morbidly Obese ◽

Obese Patients ◽

Preserved Ejection Fraction ◽

Rate Study

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H2FPEF score predicts 1-year rehospitalisation of patients with heart failure with preserved ejection fraction

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137434 ◽

2020 ◽

pp. postgradmedj-2019-137434

Author(s):

Yifei Tao ◽

Wenjing Wang ◽

Jing Zhu ◽

Tao You ◽

Yi Li ◽

...

Keyword(s):

Heart Failure ◽

Regression Analysis ◽

Ejection Fraction ◽

Cox Regression ◽

Area Under The Curve ◽

Support Vector ◽

Preserved Ejection Fraction ◽

Cox Regression Analysis ◽

Non Invasive ◽

Patients With Heart Failure

BackgroundHeart failure with preserved ejection fraction (HFpEF) has received widespread attention in recent years. There is currently a lack of valuable predictors for the prognosis of this disease. Here, we aimed to identify a non-invasive scoring system that can effectively predict 1-year rehospitalisation for patients with HFpEF.MethodsWe included 151 consecutive patients with HFpEF in a prospective cohort study and investigated the association between H2FPEF score and 1-year readmission for heart failure using multivariate Cox regression analysis.ResultsOur findings indicated that obesity, age >70 years, treatment with ≥2 antihypertensives, echocardiographic E/e’ ratio >9 and pulmonary artery pressure >35 mm Hg were independent predictors of 1-year readmission. Three models (support vector machine, decision tree in R and Cox regression analysis) proved that H2FPEF score could effectively predict 1-year readmission for patients with HFpEF (area under the curve, 0.910, 0.899 and 0.771, respectively; p<0.001).ConclusionOur study demonstrates that the H2FPEF score has excellent predictive value for 1-year rehospitalisation of patients with HFpEF.

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