Heart Failure 5-Year Outcomes

Study Questions:

What are the differences in outcomes in patients hospitalized with heart failure (HF) with preserved ejection fraction (EF) (HFpEF: EF >50%), borderline EF (HFbEF: EF 41-49%), and reduced EF (HFrEF: EF <40%)?

Methods:

The investigators linked the Get With The Guidelines-HF data to Medicare data for longitudinal follow-up. Multivariable models were constructed to examine 5-year outcomes and to compare survival to median survival of the US population.

Results:

A total of 39,982 patients from 254 hospitals who were admitted for HF between 2005 and 2009 were included: 18,299 (46%) had HFpEF, 3,285 (8.2%) had HFbEF, and 18,398 (46%) had HFrEF. Overall, median survival was 2.1 years. In risk-adjusted survival analysis, all three groups had similar 5-year mortality (HFrEF [75.3%] vs. HFpEF [75.7%] hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.958-1.022; HFbEF [75.7%] vs. HFpEF [75.7%] HR, 0.99; 95% CI, 0.947-1.046). In risk-adjusted analyses, the composite of mortality and rehospitalization was similar for all subgroups. Cardiovascular (CV) and HF readmissions rates were higher in those with HFrEF and HFbEF, compared with those with HFpEF. When compared with the US population, HF patients across all age and EF groups had markedly lower median survival.

Conclusions:

The authors concluded that among patients hospitalized with HF, patients across the EF spectrum have a similarly poor 5-year survival with an elevated risk for CV and HF admission.

Perspective:

This study reports that among those with HF, patients with HFrEF, HFbEF, and HFpEF have very high rates of 5-year mortality and rehospitalization that are similar, with and without risk adjustment. Furthermore, the median survival for patients hospitalized with HF is markedly shortened compared with those of similar age in the general US population with between 4 and 15 years of life lost. These findings highlight the substantial burden that HF places on patients and the healthcare system, irrespective of EF, and underscore the need to identify new therapies that can improve outcomes for patients with HFrEF, HFbEF, and HFpEF. Of particular concern is the suboptimal use of guideline-directed medical therapy at discharge for patients with HF, and offers an immediate opportunity to improve outcomes in this high-risk group.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Chronic Heart Failure

Keywords: AHA17, AHA Annual Scientific Sessions, Heart Failure, Heart Failure, Diastolic, Heart Failure, Systolic, Hospitalization, Medicare, Outcome Assessment (Health Care), Patient Discharge, Patient Readmission, Risk Assessment, Secondary Prevention, Stroke Volume, Survival Analysis


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