The Distribution of Left Ventricular Ejection Fraction, Characteristics, and Clinical Outcomes of Patients with Newly Diagnosed Heart Failure in Taiwan

Overview

Journal Acta Cardiol Sin

Date 2024 Nov 25

PMID 39582844

Authors

Cze Ci Chan

Hung-Chi Su

Chi Chuang

Tzyy-Jer Hsu

Fu-Chih Hsiao

Pao-Hsien Chu

Affiliations

Soon will be listed here.

Abstract

Background: Data regarding the distribution of left ventricular ejection fraction among patients with newly diagnosed heart failure (HF) and the outcomes of patients with heart failure with preserved ejection fraction (HFpEF) in Taiwan are limited.

Methods: Patients with newly diagnosed HF were identified from a multi-institutional database between 2016 and 2020. Outcomes were compared between patients with HFpEF and heart failure with reduced ejection fraction (HFrEF) after propensity score matching (PSM).

Results: Of 7,736 newly diagnosed HF patients, 4,393 (56.8%) had HFpEF and 1,977 (25.6%) had HFrEF. The HFpEF group was older (71.5 vs. 64.2 years) and more likely to be female (48.9% vs. 31.1%). Comorbidities were more common in the HFpEF patients. Median follow-up was 2.1 years. Prior to PSM, the HFpEF patients had higher all-cause mortality risk [hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.11-1.33] but lower cardiovascular (CV) death risk (HR 0.84, 95% CI 0.72-0.97) compared to those with HFrEF. The HFpEF group had a trend of higher overall hospitalization risk (HR 1.06, 95% CI 0.99-1.14), but lower HF hospitalization risk (HR 0.61, 95% CI 0.55- 0.67). After PSM, all-cause mortality and overall hospitalization were comparable. The HFpEF group had lower rates of CV death (HR 0.82, 95% CI 0.68-1.0) and HF hospitalization (HR 0.60, 95% CI 0.53-0.69) compared to the HFrEF group.

Conclusions: Among patients with newly diagnosed HF, HFpEF is the predominant phenotype, characterized by older age, higher female prevalence, and increased comorbidities. After adjusting for these factors, all-cause death and hospitalization risks became similar between the HFpEF and HFrEF patients. The HFpEF patients had lower risks of CV death and HF hospitalization.

References

Heidenreich P, Bozkurt B, Aguilar D, Allen L, Byun J, Colvin M . 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145(18):e895-e1032. DOI: 10.1161/CIR.0000000000001063. View

Yancy C, Lopatin M, Stevenson L, De Marco T, Fonarow G . Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J Am Coll Cardiol. 2006; 47(1):76-84. DOI: 10.1016/j.jacc.2005.09.022. View

. The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. Eur Heart J. 2011; 33(14):1750-7. DOI: 10.1093/eurheartj/ehr254. View

Shah K, Xu H, Matsouaka R, Bhatt D, Heidenreich P, Hernandez A . Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction: 5-Year Outcomes. J Am Coll Cardiol. 2017; 70(20):2476-2486. DOI: 10.1016/j.jacc.2017.08.074. View

Cheng R, Cox M, Neely M, Heidenreich P, Bhatt D, Eapen Z . Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population. Am Heart J. 2014; 168(5):721-30. DOI: 10.1016/j.ahj.2014.07.008. View

Chen R, Suchard M, Krumholz H, Schuemie M, Shea S, Duke J . Comparative First-Line Effectiveness and Safety of ACE (Angiotensin-Converting Enzyme) Inhibitors and Angiotensin Receptor Blockers: A Multinational Cohort Study. Hypertension. 2021; 78(3):591-603. PMC: 8363588. DOI: 10.1161/HYPERTENSIONAHA.120.16667. View

Tromp J, Teng T, Tay W, Hung C, Narasimhan C, Shimizu W . Heart failure with preserved ejection fraction in Asia. Eur J Heart Fail. 2018; 21(1):23-36. DOI: 10.1002/ejhf.1227. View

Dunlay S, Roger V, Redfield M . Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017; 14(10):591-602. DOI: 10.1038/nrcardio.2017.65. View

MacDonald M, Tay W, Teng T, Anand I, Ling L, Yap J . Regional Variation of Mortality in Heart Failure With Reduced and Preserved Ejection Fraction Across Asia: Outcomes in the ASIAN-HF Registry. J Am Heart Assoc. 2019; 9(1):e012199. PMC: 6988158. DOI: 10.1161/JAHA.119.012199. View

10.

Bhatia R, Tu J, Lee D, Austin P, Fang J, Haouzi A . Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006; 355(3):260-9. DOI: 10.1056/NEJMoa051530. View

11.

Lam C, Gamble G, Ling L, Sim D, Gerard Leong K, Daniel Yeo P . Mortality associated with heart failure with preserved vs. reduced ejection fraction in a prospective international multi-ethnic cohort study. Eur Heart J. 2018; 39(20):1770-1780. DOI: 10.1093/eurheartj/ehy005. View

12.

Vasan R, Larson M, Benjamin E, Evans J, Reiss C, Levy D . Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol. 1999; 33(7):1948-55. DOI: 10.1016/s0735-1097(99)00118-7. View

13.

Pfeffer M, Shah A, Borlaug B . Heart Failure With Preserved Ejection Fraction In Perspective. Circ Res. 2019; 124(11):1598-1617. PMC: 6534165. DOI: 10.1161/CIRCRESAHA.119.313572. View

14.

Shao S, Chan Y, Kao Yang Y, Lin S, Hung M, Chien R . The Chang Gung Research Database-A multi-institutional electronic medical records database for real-world epidemiological studies in Taiwan. Pharmacoepidemiol Drug Saf. 2019; 28(5):593-600. DOI: 10.1002/pds.4713. View

15.

Borlaug B . Evaluation and management of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2020; 17(9):559-573. DOI: 10.1038/s41569-020-0363-2. View

16.

Ziaeian B, Fonarow G . Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016; 13(6):368-78. PMC: 4868779. DOI: 10.1038/nrcardio.2016.25. View

17.

Chioncel O, Lainscak M, Seferovic P, Anker S, Crespo-Leiro M, Harjola V . Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017; 19(12):1574-1585. DOI: 10.1002/ejhf.813. View

18.

McDonagh T, Metra M, Adamo M, Gardner R, Baumbach A, Bohm M . 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36):3599-3726. DOI: 10.1093/eurheartj/ehab368. View

19.

Jonsson A, Edner M, Alehagen U, Dahlstrom U . Heart failure registry: a valuable tool for improving the management of patients with heart failure. Eur J Heart Fail. 2009; 12(1):25-31. DOI: 10.1093/eurjhf/hfp175. View

20.

Conrad N, Judge A, Tran J, Mohseni H, Hedgecott D, Crespillo A . Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet. 2017; 391(10120):572-580. PMC: 5814791. DOI: 10.1016/S0140-6736(17)32520-5. View