Michelle Bozko Collini et al. Gustavo Sarot Pereira da Cunha Leonardo Henrique dos Santos de Melo Matheus Bissa Duarte Ferreira … Jorge Tadashi Daikubara Neto Rafael Moretti Carolina Ruschel Senger Karoline Cordeiro Vercka Jessica Tamires Reichert Lucas Muller Prado Jamilly Giuriatti Anziliero Eduardo Leal Adam Raphael Henrique Déa Cirino Miguel Morita Fernandes-Silva
Abstract
Background:
The universal classification of heart failure (HF) defined four categories based on ejection fraction (EF). Although it has been shown these EF-based categories have distinct prognoses and responses to treatment, most of the data has been focused on chronic HF.
Objectives:
We compared the prognosis and characteristics of patients with acute HF according to the universal EF classification.
Methods:
We performed a prospective cohort study of patients admitted to a tertiary hospital for acute HF. Patients were classified into the four categories of the universal EF classification: reduced (HFrEF), mildly reduced (HFmrEF), preserved (HFpEF), and improved (HFimpEF), based on an echocardiogram conducted during the hospitalization. The primary outcome was all-cause death in six months of follow-up.
Results:
153 patients hospitalized for acute HF (67.2 ± 14.9 years, 50.3% female, EF = 43.8 ± 17.6%) were included, being 52% HFrEF, 35% HFpEF, 12% HFmrEF, and 1% HFimpEF. HFrEF patients were more likely to have an ischemic etiology (42.5%), while HFpEF patients were more likely female (67.3%), had hypertension (90.9%) and atrial fibrillation (49.1%). Six-month mortality was similar among HFrEF, HFpEF, and HFmrEF categories (15% vs 20% vs 11%, respectively, Log-rank p = 0.75), and change in EF from a previous echocardiogram was not associated with outcomes.
Conclusion:
In patients with acute HF, the EF categories from the universal classification had similar mortality rates. The proportion of patients with improved EF was very small in patients with acute HF and improvement of EF was not associated with better outcomes.
