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A comprehensive population-based characterization of heart failure with mid-range ejection fraction
Natl Heart Ctr Singapore, 5 Hosp Dr, Singapore 169609, Singapore.;Duke NUS Med Sch, Singapore, Singapore..
Natl Heart Ctr Singapore, 5 Hosp Dr, Singapore 169609, Singapore..
Natl Heart Ctr Singapore, 5 Hosp Dr, Singapore 169609, Singapore.;Univ Western Australia, Sch Populat Hlth, Perth, WA, Australia..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala Univ, Dept Med Sci, Uppsala, Sweden.;Uppsala Clin Res Ctr UCR, Uppsala, Sweden..
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2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no 12, p. 1624-1634Article in journal (Refereed) Published
Abstract [en]

Aims: Clinical features and outcomes in the novel phenotype heart failure with mid-range ejection fraction [HFmrEF, ejection fraction (EF) 40-49%] were compared with heart failure with reduced EF (HFrEF, EF < 40%) and preserved EF (HFpEF, EF >= 50%).

Methods and results: In the Swedish Heart Failure Registry, we assessed the association between baseline characteristics and EF group using multivariable logistic regressions, and the association between EF group and all-cause mortality using multivariable Cox regressions. Of 42 061 patients, 56% had HFrEF, 21% had HFmrEF, and 23% had HFpEF. Characteristics were continuous for age (72 +/- 12 vs. 74 +/- 12 vs. 77 +/- 11 years), proportion of women (29% vs. 39% vs. 55%), and 13 other characteristics. Coronary artery disease (CAD) was distinctly more common in HFrEF (54%) and HFmrEF (53%) vs. HFpEF (42%); adjusted odds ratio for CAD in HFmrEF vs. HFpEF was 1.52 [95% confidence interval (CI) 1.41-1.63]. For six additional characteristics HFmrEF resembled HFrEF, for seven characteristics HFmrEF resembled HFpEF, and for 10 characteristics there was no pattern. The adjusted hazard ratio (HR) for mortality in HFrEF vs. HFpEF was 1.35 (95% CI 1.14-1.60) at 30 days, 1.26 (95% CI 1.17-1.35) at 1 year, and 1.20 (95% CI 1.14-1.26) at 3 years. In contrast, HFmrEF and HFpEF had a similar prognosis (HR 1.06, 95% CI 0.86-1.30 at 30 days; HR 1.08, 95% CI 1.00-1.18 at 1 year; and HR 1.06, 95% CI 1.00-1.12 at 3 years). Three-year mortality was higher in HFmrEF than in HFpEF in the presence of CAD (HR 1.11, 95% CI 1.02-1.21), but not in the absence of CAD (HR 1.02, 95% CI 0.94-1.12; P for interaction < 0.001).

Conclusions: HFmrEF was an intermediate phenotype, except that CAD was more common in HFmrEF and HFrEF vs. HFpEF, crude all-cause mortality was lower in HFmrEF and HFrEF, adjusted all-cause mortality was lower in HFmrEF and HFpEF, and CAD portended a higher adjusted risk of death in HFmrEF and HFrEF.

Place, publisher, year, edition, pages
WILEY , 2017. Vol. 19, no 12, p. 1624-1634
Keywords [en]
Heart failure, Mid-range ejection fraction, Preserved ejection fraction, Phenotype, Coronary artery disease, Mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-340267DOI: 10.1002/ejhf.945ISI: 000418671800010PubMedID: 28948683OAI: oai:DiVA.org:uu-340267DiVA, id: diva2:1179131
Funder
Swedish National Board of Health and WelfareSwedish Association of Local Authorities and RegionsSwedish Research Council, 2013-23897-104604-23, 523-2014-2336Swedish Heart Lung Foundation, 20100419, 20120321Stockholm County Council, 20110120, 20140220Swedish Society of Medicine, 174111, 504881Available from: 2018-01-31 Created: 2018-01-31 Last updated: 2018-01-31Bibliographically approved

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