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J Am Coll Cardiol, 2003; 41:1510-1518, doi:10.1016/S0735-1097(03)00185-2
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH

Outcomes in heart failure patients with preserved ejection fraction

Mortality, readmission, and functional decline

Grace L. Smith, MPH*, Frederick A. Masoudi, MD, MSPH, FACC{dagger}, Viola Vaccarino, MD, PhD{ddagger}, Martha J. Radford, MD, FACC*§|| and Harlan M. Krumholz, MD, FACC*§||¶,*

* Yale–New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA
{dagger} Division of Cardiology, Denver Health Medical Center, Denver, Colorado, USA
{ddagger} Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
§ Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
|| Qualidigm, Middletown, Connecticut, USA
Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA

Manuscript received March 29, 2002; revised manuscript received October 7, 2002, accepted October 31, 2002.

* Reprint requests and correspondence: Dr. Harlan M. Krumholz, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208025, New Haven, Connecticut 06520-8025, USA.
harlan.krumholz{at}yale.edu

OBJECTIVES: We evaluated the six-month clinical trajectory of patients hospitalized for heart failure (HF) with preserved ejection fraction (EF), as the natural history of this condition has not been well established. We compared mortality, hospital readmission, and changes in functional status in patients with preserved versus depressed EF.

BACKGROUND: Although the poor prognosis of HF with depressed EF has been extensively documented, there are only limited and conflicting data concerning clinical outcomes for patients with preserved EF.

METHODS: We prospectively evaluated 413 patients hospitalized for HF to determine whether EF ≥40% was an independent predictor of mortality, readmission, and the combined outcome of functional decline or death.

RESULTS: After six months, 13% of patients with preserved EF died, compared with 21% of patients with depressed EF (p = 0.02). However, the rates of functional decline were similar among those with preserved and depressed EF (30% vs. 23%, respectively; p = 0.14). After adjusting for demographic and clinical covariates, preserved EF was associated with a lower risk of death (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.26 to 0.90; p = 0.02), but there was no difference in the risk of readmission (HR 1.01, 95% CI 0.72 to 1.43; p = 0.96) or the odds of functional decline or death (OR 1.01, 95% CI 0.59 to 1.72; p = 0.97).

CONCLUSIONS: Heart failure with preserved EF confers a considerable burden on patients, with the risk of readmission, disability, and symptoms subsequent to hospital discharge, comparable to that of HF patients with depressed EF.

Abbreviations and Acronyms
  ACE = angiotensin-converting enzyme
  ADL = activities of daily living
  CI = confidence interval
  EF = ejection fraction
  HF = heart failure
  HR = hazard ratio
  OR = odds ratio
  V-HeFT = Veterans Administration Heart Failure Trial




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