
Does Mortality Differ Among Patients With Certain Subtypes of Heart Failure?
Patients hospitalized due to acute decompensated heart failure have both a higher rate of annual mortality, compared with patients who have chronic ambulatory heart failure, and of dying within 6 months of hospital release.
Nearly 20% of patients hospitalized due to acute decompensated
Drilling down to 3 subtypes—HF with reduced ejection fraction (HFrEF), HF with midrange ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF)—a team from Japan looked to uncover if there were apparent distinctions among these subgroups of patients where death rate and mode of death were concerned. Their
The population of 3717 was culled from data already collected through the multicenter prospective cohort
- HFrEF: less than 40%
- HFmrEF: 40% to 49%
- HFpEF: 50% or higher
Overall, the mean (SD) patient age was 77.7 (12.0) years, and 55.1% were male. In addition, close to 27% had HF, with mean (SD) systolic and diastolic blood pressures of 116 (18) and 64 (12) mm Hg, respectively. The mean (SD) LVEF was 46.4% (16.2%), and by HF subtype, 37.2% (1383) had HFrEF; 18.9% (703), HFmrEF; and 43.9% (1631), HFpEF. There was also a median follow-up of 470 days (interquartile range, 357-649), and a 1-year follow-up of 96%.
All-cause mortality was shown to not differ significantly among the subtypes, with all totals coming in at less than 25%:
- HFrEF: 21.6% (95% CI, 19.5%-23.8%)
- HFmrEF: 22.5% (95% CI, 19.5%-25.7%)
- HRpEF: 24.0% (95% CI, 22.0%-26.2%; P = .26)
Similar results were seen when rates of cardiovascular-related and sudden cardiac death (SCD) were investigated:
- Cardiovascular-related deaths: HFrEF: 14.7% (95% CI, 12.9%-16.6%) HFmrEF: 13.8% (95% CI, 11.4%-16.5%) HRpEF: 13.7% (95% CI, 12.1%-15.4%; P = .71)
- Sudden cardiac death: HFrEF: 3.2% (95%CI, 2.4%-4.2%) HFmrEF: 2.0% (95% CI, 1.2%-3.3%) HRpEF: 2.5% (95% CI, 1.8%-3.3%)
What differed were the origins of the HF. Patients with HFrEF had disease that with an
To make progress in more specialized treatment for these patients, the study authors suggest additional studies are needed “to identify a high-risk subset in this population,” as well as a comprehensive understanding of how and why these patients die.
“The incidences of cardiovascular death and sudden cardiac death were comparable among the heart failure subtypes. Use of β-blockers and ACEIs or [angiotensin receptor blockers] was associated with lower mortality in patients with HFpEF and HFmrEF,” they concluded. “Given the nonnegligible incidence of SCD in patients with HFpEF, an additional study appears to be warranted to identify the high-risk subset in this population.”
Reference
Kitai T, Miyakoshi C, Morimoto T, et al. Mode of Death Among Japanese Adults With Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction. JAMA Network Open. 2020;3(5):e204296. doi:10.1001/jamanetworkopen.2020.4296
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