Patients with heart failure and midrange ejection fraction (HFmrEF; left ventricular ejection fraction [LVEF] of 41-49 percent) have different disease characteristics and risk factors compared with patients with other forms of HF, thus require different treatment strategies, according to a study of patients published in ESC Heart Failure.

Nasrien E. Ibrahim, MD, FACC, et al., analyzed data for 1,824,964 patients with a diagnosis of HF collected from 2008 through 2016 in the PINNACLE Registry. Of those patients, 721,578 were excluded from the analysis because of missing LVEF or gender data, or were younger than age 18. Of the 1,103,386 remaining patients, 36.1 percent had HF with reduced EF (HFrEF; LVEF ≤40 percent), 56.5 percent had HF preserved EF (HFpEF; LVEF ≥50 percent) and 7.5 percent had HFmrEF. The mean LVEF at the index visit was 29.6 percent, 60.2 percent and 45 percent, respectively.

To better understand the trajectory of LVEF, researchers examined changes in LVEF in the 82,292 (26.1 percent) of HFmrEF patients who had an LVEF available prior to the index visit: 62.3 percent had HFmrEF at both time points, 32.9 percent progressed from HFpEF to HFmrEF and 4.8 percent improved from HFrEF to HFmrEF.

Researchers also found that patients with HFmrEF had different disease characteristics than patients in other HF categories. Patients with HFmrEF had a distinct atherothrombotic profile, with more prevalent atrial fibrillation/flutter, diabetes, chronic kidney disease and tobacco use. In addition, they were more likely to have a history of coronary artery disease, peripheral artery disease or prior myocardial infarction and to have had a PCI or CABG.

"Patients with HFmrEF in the PINNACLE Registry have a unique profile characterized by high prevalence of vascular disease and atherothrombotic risk factors when compared with those with HFrEF or HFpEF," write the study's authors. "Care strategies for patients with HFmrEF may thus differ from other forms of HF. More studies are needed to better understand how to individualize therapy for patients with HFmrEF."

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Interventions and Coronary Artery Disease, Interventions and Vascular Medicine

Keywords: PINNACLE Registry, National Cardiovascular Data Registries, Coronary Artery Disease, Peripheral Arterial Disease, Risk Factors, Stroke Volume, Prevalence, Atrial Fibrillation, Heart Failure, Ventricular Function, Left, Registries, Diabetes Mellitus, Myocardial Infarction, Renal Insufficiency, Chronic, Tobacco Use, Phenotype, Percutaneous Coronary Intervention

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