Abstract 9759: Race and Gender Differences in Survival Among Hospitalized Heart Failure With Preserved Ejection Fraction: The Atherosclerosis Risk in Communities (ARIC) Surveillance Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kavita Sharma ◽  
Sunil K Agarwal ◽  
Lisa M Wrick ◽  
Kunihiro Matsushita ◽  
Patricia P Chang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Patient Characteristics ◽  
Preserved Ejection Fraction ◽  
Washington County ◽  
Atherosclerosis Risk In Communities ◽  
Race And Gender ◽  
Gender Based ◽  
And Gender ◽  
Forsyth County

Background: Heart failure with preserved ejection fraction (HFpEF) accounts for about half of HF hospitalizations, and has been reported to be more common amongst Caucasians and women in outpatient population studies. There are limited data, however, on the influence of race and gender on survival in HFpEF. We evaluated whether clinical characteristics and outcomes differ amongst HFpEF patients by race and gender. Methods: HFpEF (EF≥ 50%) hospitalization cases from 2005-2009 adjudicated by a physician panel were analyzed from the community-based surveillance component of the ARIC study, comprising 4 US communities (Jackson, MS; Washington County, MD; Minneapolis, MN; and Forsyth County, NC; combined population in 2009 = 214,000). The association of race and gender with mortality at 28-days and 1-year was evaluated. Results: Of 3,786 (weighted n = 18,265) adjudicated acute decompensated HF cases, 1,726 (weighted n = 8114) were categorized as HFpEF. Patient characteristics included: female (44%), African American (AA, 32%), hypertension (83%), diabetes (46%), and mean BMI of 28. Compared to Caucasians, AA’s were younger (70 vs. 77 years, p<0.001), more frequently women (47% vs. 42%, p<0.001), with higher systolic blood pressure (SBP, 145 vs. 135 mmHg, p<0.001), and more prior HF hospitalizations (50% vs. 37%, p<0.001). Compared to men, women were older (76 vs. 73 years, p<0.001), with higher SBP (141 vs. 138 mmHg, p=0.03), and better renal function (eGFR 42 vs. 38 mL/min/1.73m 2 , p<0.001). Overall 28-day and 1-year mortality was 13.1% and 32.8%, respectively, with no differences in un-adjusted or adjusted estimates by race or gender (Table 1). Conclusions: In hospitalized HFpEF patients, overall 28-day and 1-year mortality were high without apparent race- or gender-based differences in mortality. These data may help inform the development of future interventions and resource allocation.

Abstract 18870: Adjudicated versus “Administrative” Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Andreas P Kalogeropoulos ◽  
Akash Patel ◽  
Song Li ◽  
Gregory Burkman ◽  
Lampros Papadimitriou ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Administrative Data ◽  
Medical Records ◽  
Patient Characteristics ◽  
Preserved Ejection Fraction ◽  
Icd Codes ◽  
And Gender ◽  
Special Causes

Introduction: The proportion of heart failure (HF) with preserved ejection fraction (HFpEF) is reported to be as high as 40%-60% based on administrative data, but these estimates have not been clinically validated. Methods: We evaluated 1752 consecutive patients who received outpatient care during the first quarter of 2012 for an encounter ICD-9 code of 402.X1, 404.X1, 404.X3, or 428.XX. Medical records were reviewed for HF symptoms, signs, and treatment; last reported ejection fraction (EF); all previous EF documentations; and special causes of HF (congenital heart disease or specific cardiomyopathies). We classified confirmed HF cases not due to special causes into 3 mutually exclusive categories: (1) HFpEF: current EF >40% without any previous EF ≤40%; (2) HF with recovered EF (HFrecEF): current EF >40% but previous EF ≤40%; and (3) HF with reduced EF (HFrEF): current EF ≤40%. Results: HF was confirmed in 1652 cases (94.3%). Among these, 321 had HFpEF (19.4%; 95%CI 17.6-21.4); 268 had HFrecEF (16.2%; 95%CI 14.5-18.1); and 992 had HFrEF (60.0%; 95%CI 57.7-62.4); the remaining 71 cases (4.3%) had HF due to special causes. In comparison, the proportion of HFpEF on the basis of ICD codes and last EF without further adjudication would have been 39.0%. Patient characteristics are summarized in Table 1. After 2 years of follow up, age- and gender- adjusted mortality was 10.2% in HFrEF, 8.6% in HFpEF, and 4.4% in HFrecEF patients (stratified log-rank P=0.005), Fig. 1 . Conclusions: The proportion of clinically verified HFpEF is considerably lower compared to estimates from administrative data. Many patients with preserved EF actually represent HFrecEF, which has a more favorable prognosis.

128Change in geriatric nutritional risk index predicts one-year mortality in patients with heart failure with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Sunaga ◽  
S Hikoso ◽  
T Yamada ◽  
Y Yasumura ◽  
M Uematsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Risk Index ◽  
Patient Characteristics ◽  
Nutritional Risk ◽  
Preserved Ejection Fraction ◽  
Nutritional Risk Index ◽  
Patients With Heart Failure ◽  
One Year

Abstract Background Malnutrition is associated with adverse prognosis in heart failure patients. However, in patients with heart failure with preserved ejection fraction (HFpEF), the effects of change in nutritional status during hospitalization on prognosis is unknown. Geriatric nutritional risk index (GNRI) is a widely used objective index for evaluating nutritional status. Low GNRI (<92) has moderate or severe nutritional risk and high GNRI (≥92) has no or low nutritional risk. Purpose The purpose of this study was to clarify the effect of change in GNRI during hospitalization on one-year mortality and the association between the value of GNRI and one-year mortality in patients with HFpEF. Methods We prospectively registered patients with HFpEF in PURSUIT-HFpEF registry when they were hospitalized for heart failure in 29 hospitals. Preserved ejection fraction was defined as more than 50% of left ventricular ejection fraction. Of the 486 patients who registered PURSUIT-HFpEF, 228 cases with one-year follow-up data were examined. GNRI was calculated as follows: 14.89 × serum albumin (g/dl) + 41.7 × body mass index/22. Results Mean age was 81±10 years and 100 patients (44%) were male. During a median [interquartile range] follow-up period of 374 [342, 400] days, 28 patients (12%) died. Mortality was significantly higher in patients with low GNRI at admission (n=65) than those with high GNRI at admission (n=163) (26% vs. 9%, log-rank P=0.011) and higher in patients with low GNRI at discharge (n=109) than those with high GNRI at discharge (n=119) (22% vs. 6%, log-rank P=0.002). Multivariate analysis with Cox proportional hazard model with patient characteristics at admission revealed that low GNRI at admission was independently associated with mortality (hazard ratio: 0.96, 95% CI: 0.93–0.99, P=0.035) and that with patient characteristics at discharge revealed that low GNRI at discharge was independently associated with mortality (hazard ratio: 0.94, 95% CI: 0.91–0.97, P<0.001). We also compared mortality by dividing patients into 4 group according to whether GNRI was high or low at the time of admission and discharge. Patients with low GNRI at admission and at discharge (n=59) exhibited the highest mortality, on the other hand, patients with high GNRI at admission and low GNRI at discharge (n=50) exhibited higher mortality than those with high GNRI both at admission and at discharge (n=113) (Low and low: 28% vs. High and low: 14% vs. High and high: 6% vs. Low and high: 0%, log-rank P=0.010). All cause mortality Conclusion GNRI at admission or at discharge was independently associated with one-year mortality in patients with HFpEF. Moreover, worsening GNRI during hospitalization is associated with the worse prognosis. It is important to prevent lowering GNRI during treatment of acute decompensated HFpEF. Acknowledgement/Funding Roche Diagnostics, FUJIFILM Toyama Chemical

Heart Failure with Preserved Ejection Fraction: Hospitalization and Patient Characteristics from an Urban Population

2014 ◽  
Vol 20 (8) ◽  
pp. S114-S115
Author(s):  
Kavita Sharma ◽  
Terence Hill ◽  
Stuart D. Russell ◽  
Morgan Grams ◽  
David A. Kass ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Urban Population ◽  
Patient Characteristics ◽  
Preserved Ejection Fraction

Abstract 12221: Impact of Serum Uric Acid on Mortality in Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Takeshi Shimizu ◽  
Akiomi Yoshihisa ◽  
Mai Takiguchi ◽  
Shunsuke Miura ◽  
Akihiko Sato ◽  
...  
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Ejection Fraction ◽  
Serum Uric Acid ◽  
Patient Characteristics ◽  
Decompensated Heart Failure ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
All Cause Mortality ◽  
The Impact

Background: Serum uric acid is a predictor of cardiovascular mortality in heart failure with reduced ejection fraction. However, the impact of uric acid on heart failure with preserved ejection fraction (HFpEF) remains unclear. Here we investigated the association between hyperuricemia and mortality in HFpEF patients. Methods and Results: Consecutive 424 patients, who admitted to our hospital for decompensated heart failure and diagnosed as HFpEF, were divided into two groups based on presence of hyperuricemia (serum uric acid ≥ 7 mg/dl). We compared patient characteristics, cardio-ankle vascular index and cardio-pulmonary exercise test findings between the two groups. Furthermore, we prospectively followed cardiac and all-cause mortality. The hyperuricemia group (n=254), as compared with non-hyperuricemia group (n=170), had higher prevalence of male gender (55.5 vs. 41.7%, P=0.005), hypertension (79.9 vs. 69.4%, P=0.013), diabetes mellitus (38.5 vs. 26.4%, P=0.010) and use of diuretics (72.4 vs. 41.7%, P<0.001). Furthermore, the hyperuricemia group had higher levels of B-type natriuretic peptide (112.3 vs. 71.4 pg/ml, P<0.001), lower levels of estimated GFR (53.2 vs. 69.7 ml/min/1.73m 2 , P<0.001), higher cardio-ankle vascular index (8.7 vs. 7.5, P<0.001), lower peak VO 2 (14.9 vs. 17.9 ml/kg/min, P<0.001) and higher VE/VCO 2 slope (34.9 vs. 31.9, P=0.02) compared with non-hyperuricemia group. In the follow up period (mean of 897 days), cardiac and all-cause mortalities were significantly higher in those with hyperuricemia (P=0.006 and P=0.004, respectively). In the multivariable Cox proportional hazard analyses after adjusting for confounding factors including chronic kidney disease and use of diuretics, hyperuricemia was an independent predictor of all-cause mortality (hazard ratio 1.98, P=0.039). Conclusion: Hyperuricemia is associated with arterial stiffness, impaired exercise capacity, and high mortality in HFpEF.

scholarly journals Difference in Prognosis between Continuation and Discontinuation of A 5-Month Cardiac Rehabilitation Program in Outpatients with Heart Failure with Preserved Ejection Fraction

2021 ◽  
Vol 10 (15) ◽  
pp. 3306
Author(s):  
Hidetaka Morita ◽  
Yasunori Suematsu ◽  
Kai Morita ◽  
Yuiko Yano ◽  
Maaya Sakamoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Clinical Outcomes ◽  
Hospital Admissions ◽  
Patient Characteristics ◽  
Rehabilitation Program ◽  
Preserved Ejection Fraction ◽  
Cardiac Rehabilitation Program ◽  
Patients With Heart Failure

Background: Cardiac rehabilitation (CR) is a requisite component of care for patients with heart failure (HF). We aimed to evaluate the clinical outcomes in outpatients with HF with preserved ejection fraction (HFpEF) compared to those in patients with non-HFpEF who did and did not continue a 5-month CR program. Methods: 173 outpatients with HF who participated in a 5-month CR program were registered. We divided them into two groups: HFpEF (n = 84, EF 63 ± 7%) and non-HFpEF (n = 89, EF 31 ± 11%). We further divided the patients into those who continued the CR program (continued group) and those who did not (discontinued group) in the HFpEF and non-HFpEF groups. The clinical outcomes at 5 months were compared among the groups. Results: There were no significant differences in patient characteristics at baseline between the continued and discontinued groups in the HFpEF and non-HFpEF groups except for % diabetes mellitus in the non-HFpEF group. The rates of all-cause death and hospital admissions in the continued group in both the HFpEF and non-HFpEF groups were significantly lower than those in the discontinued group. The all-cause death and hospital admissions in each group were independently associated with the continuation of the CR program. Conclusions: The continuation of a 5-month CR program was associated with the prevention of all-cause death and hospital admissions in both the HFpEF and non-HFpEF groups.

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