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Patient-reported and Clinical Outcomes Among Patients Hospitalized for Heart Failure With Reduced Versus Preserved Ejection Fraction

      Abstract

      Background

      Differences between patients hospitalized for heart failure with reduced ejection fraction (HFrEF) vs HF with preserved EF (HFpEF) are not well-characterized, particularly as pertains to in-hospital decongestion and longitudinal patient-reported outcomes. The objective of this analysis was to compare patient-reported and clinical outcomes between patients hospitalized with HFrEF vs HFpEF.

      Methods and Results

      The Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial enrolled 7141 patients hospitalized for HF with reduced or preserved EF. We assessed the association between an EF ≤ 40% vs an EF >40% with in-hospital decongestion, risk of rehospitalization and mortality, and quality of life as measured by the EuroQOL 5 Dimensions (EQ-5D). Among 5800 patients (81%) with complete EF data, 4782 (82%) had an EF ≤40% and 1018 (18%) had an EF >40%. Both groups demonstrated similar rates of decongestion by weight change and urine volume through 24 hours, a similar risk of 30-day mortality and HF rehospitalization, and a similar 180-day mortality. Patients with HFpEF had worse EQ-5D scores at hour 24 (median 0.76, [interquartile range (IQR) 0.51–0.84] vs 0.78 [IQR 0.57–0.84]; P = .01) that persisted through discharge (0.81 [IQR 0.69–0.86] vs 0.83 [IQR 0.71–1.00]; P < .001) and the 30-day follow-up (0.78 [IQR 0.60–0.85] vs 0.83 [IQR 0.71–1.00]; P < .001). After adjustment, these differences were attenuated and not statistically significant.

      Conclusions

      In this large, multinational cohort of patients hospitalized for HF, patients with an EF ≤ 40% vs an EF >40% experienced similar in-hospital decongestion and postdischarge clinical outcomes. Patients with an EF >40% reported worse in-hospital and postdischarge patient-reported health status, but these measures were similar to HFrEF after accounting for other clinical factors.

      Key Words

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      Linked Article

      • Considerations in the Interpretation of Patient Reported Outcomes in Heart Failure with Reduced and Preserved Ejection Fraction
        Journal of Cardiac Failure
        • Preview
          Patient reported outcomes (PROs) are an important and increasingly common component of clinical research, particularly in heart failure (HF), where interest in PROs has gained ground in recent years [1]. As HF is a disease process notorious for its plethora of symptoms and vast range of available medications and therapies, PROs help focus research on patient-centered care and help balance quality of life metrics with traditional mortality reporting [2]. PROs are particularly important in HF studies that have have shown that patient preferences vary widely in terms of aggressiveness of medical treatment and time versus quality of life tradeoffs [3].
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