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CLINICAL RESEARCH: HEART FAILURE

Characteristics, Treatments, and Outcomes of Patients With Preserved Systolic Function Hospitalized for Heart Failure

A Report From the OPTIMIZE-HF Registry

Gregg C. Fonarow, MD, FACC^_*,_*, Wendy Gattis Stough, PharmD, William T. Abraham, MD, FACC, Nancy M. Albert, PhD, RN, Mihai Gheorghiade, MD, FACC^||, Barry H. Greenberg, MD, FACC^¶, Christopher M. O’Connor, MD, FACC^#, Jie Lena Sun, MS^_**, Clyde W. Yancy, MD, FACC, James B. Young, MD, FACC for the OPTIMIZE-HF Investigators and Hospitals

^_* Department of Medicine, UCLA Medical Center, Los Angeles, California
Department of Medicine, Duke University Medical Center, Durham, North Carolina, and Department of Clinical Research, Campbell University School of Pharmacy, Research Triangle Park, North Carolina
Division of Cardiology, Ohio State University, Columbus, Ohio
George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio
^|| Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
^¶ Department of Medicine, USCD Medical Center, San Diego, California
^# Division of Cardiology, Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina
^_** Duke Clinical Research Institute, Durham, North Carolina
Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas (formerly Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, Texas)
Department of Cardiovascular Medicine, Heart Failure Section, Cleveland Clinic Foundation, Cleveland, Ohio.

Manuscript received December 12, 2006; revised manuscript received April 20, 2007, accepted April 23, 2007.

^_* Reprint requests and correspondence: Dr. Gregg C. Fonarow, Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, 10833 LeConte Avenue, Room 47-123 CHS, Los Angeles, California 90095-1679. (Email: gfonarow{at}mednet.ucla.edu).

Objectives: We sought to evaluate the characteristics, treatments, and outcomes of patients with preserved and reduced systolic function heart failure (HF).

Background: Heart failure with preserved systolic function (PSF) is common but not well understood.

Methods: This analysis of the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry compared 20,118 patients with left ventricular systolic dysfunction (LVSD) and 21,149 patients with PSF (left ventricular ejection fraction [EF] 40%). Sixty- to 90-day follow-up was obtained in a pre-specified 10% sample of patients. Analyses of patients with PSF defined as EF >50% were also performed for comparison.

Results: Patients with PSF (EF 40%) were more likely to be older, female, and Caucasian and to have a nonischemic etiology. Although length of hospital stay was the same in both groups, risk of in-hospital mortality was lower in patients with PSF (EF 40%) (2.9% vs. 3.9%; p < 0.0001). During 60- to 90-day post-discharge follow-up, patients with PSF (EF 40%) had a similar mortality risk (9.5% vs. 9.8%; p = 0.459) and rehospitalization rates (29.2% vs. 29.9%; p = 0.591) compared with patients with LVSD. Findings were comparable with those with PSF defined as EF >50%. In a risk- and propensity-adjusted model, there were no significant relationships between discharge use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or beta-blocker and 60- to 90-day mortality and rehospitalization rates in patients with PSF.

Conclusions: Data from the OPTIMIZE-HF registry reveal a high prevalence of HF with PSF, and these patients have a similar post-discharge mortality risk and equally high rates of rehospitalization as patients with HF and LVSD. Despite the burden to patients and health care systems, data are lacking on effective management strategies for patients with HF and PSF. (Organized Program To Initiate Lifesaving Treatment In Hospitalized Patients With Heart Failure [OPTIMIZE-HF]); http://www.clinicaltrials.gov/ct/show/NCT00344513?order=1; NCT00344513 [ClinicalTrials.gov] )

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ARB = angiotensin receptor blocker   EF = ejection fraction   HF = heart failure   LVSD = left ventricular systolic dysfunction   PSF = preserved systolic function

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