CLINICAL RESEARCH: HEART FAILURE
Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction
Results of the New York heart failure registry
Marc Klapholz, MD*,
Matthew Maurer, MD ,
April M. Lowe, MS ,
Frank Messineo, MD ,
Jay S. Meisner, MD, PhD||,
Judith Mitchell, MD¶,
Jill Kalman, MD#,
Robert A. Phillips, MD, PhD**,
Richard Steingart, MD,
Edward J. Brown, Jr, MD,
Robert Berkowitz, MD, PhD,
Robert Moskowitz, MD||||,
Anita Soni, MD¶¶,
Donna Mancini, MD,
Rachel Bijou, MD,
Khashayar Sehhat, MD***,
Nikita Varshneya, MD*,
Marrick Kukin, MD**,
Stuart D. Katz, MD,
Lynn A. Sleeper, ScD,
Thierry H. Le Jemtel, MD*, New York Heart Failure Consortium
* Saint Vincent Catholic Medical Centers, New York, New York, USA
Columbia Presbyterian Medical Center, New York, New York, USA
New England Research Institutes, Watertown, Massachusetts, USA
New York Hospital, Queens, New York, USA
|| Jacobi Medical Center, Bronx, New York, USA
¶ SUNY Health Science Center, Brooklyn, New York, USA
# Beth Israel Medical Center, New York, New York, USA
** Mount Sinai Medical Center, New York, New York, USA
Winthrop Hospital, Mineola, New York, USA
Lincoln Hospital, Bronx, New York, USA
Valley Hospital, Ridgewood, New Jersey, USA
|||| Montefiore Medical Center, Bronx, New York, USA
¶¶ Bronx Lebanon Hospital, Bronx, New York, USA
*** Our Lady of Mercy Medical Center, Bronx, New York, USA
Albert Einstein College of Medicine, Bronx, New York, USA
Manuscript received May 27, 2003;
revised manuscript received November 8, 2003,
accepted November 17, 2003.
* Reprint requests and correspondence: Dr. Thierry H. Le Jemtel, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461, USA.
lejemtel{at}aecom.yu.edu
OBJECTIVES: We conducted a prospective multicenter registry in a large metropolitan area to define the clinical characteristics, hospital course, treatment, and factors precipitating decompensation in patients hospitalized for heart failure with a normal ejection fraction (HFNEF).
BACKGROUND: The clinical profile of patients hospitalized for HFNEF has been characterized by retrospective analyses of hospital records and state data banks, with few prospective single-center studies.
METHODS: Patients hospitalized for heart failure (HF) at 24 medical centers in the New York metropolitan area and found to have a left ventricular (LV) ejection fraction of  50% within seven days of admission were included in this registry. Patient demographics, signs and symptoms of HF, coexisting and exacerbating cardiovascular and medical conditions, treatment, laboratory tests, procedures, and hospital outcomes data were collected. Analysis by gender and race was prespecified.
RESULTS: Of 619 patients, 73% were women, who were on average four years older than men (72.8 ± 14.1 years vs. 68.6 ± 13.8 years, p < 0.001). Black non-Hispanic patients comprised 30% of the study population. They were eight years younger than other patients (66.0 ± 14.2 years vs. 74 ± 13.5 years p < 0.001). Co-morbid conditions and their prevalence were: hypertension, 78%; increased LV mass, 82%; diabetes, 46%; and obesity, 46%. Before clinical decompensation that precipitated hospitalization, 86% of patients had chronic symptoms compatible with New York Heart Association functional classes II to IV. Factors precipitating clinical decompensation were identified in 53% of patients. In-hospital mortality was 4.2%.
CONCLUSIONS: Patients hospitalized for HFNEF are most often chronically incapacitated elderly women with a history of hypertension and increased LV mass. Reasons for clinical decompensation are identified in only one-half of patients.
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Abbreviations and Acronyms
| | B-NH | = black non-Hispanic | | BP | = blood pressure | | EF | = ejection fraction | | GFR | = glomerular filtration rate | | HF | = heart failure | | HFNEF | = heart failure with normal ejection fraction | | LV | = left ventricle/ventricular |
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