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…

By C. Yancy, M. Lopatin, L. Stevenson, T. De Marco, G. Fonarow. Journal of the American College of Cardiology, 2006

1,007 citations recorded by the source corpus.

UNLABELLED Approximately 50% of patients hospitalized for heart failure have preserved systolic function. These patients are more likely to be older, women, and hypertensive. Their duration of hospitalization is similar to that of heart failure patients with systolic dysfunction, but their in-hospital mortality risk is lower. This mortality risk is increased in the setting of renal insufficiency, and the two most important risk predictors are elevated blood urea nitrogen and systolic blood pressure < or = 125 mm Hg. Medical treatment strategies for patients with preserved systolic function are inconsistent and reflect the need for efficacious evidence-based treatment regimens. OBJECTIVES The aims of this analysis were to describe the clinical characteristics, management, and outcomes of patients hospitalized for acute decompensated heart failure (HF) with preserved systolic function (PSF). BACKGROUND Clinically meaningful characteristics of these patients have not been fully studied in a large database. METHODS Data from >100,000 hospitalizations from the Acute Decompensated Heart Failure National Registry (ADHERE) database were analyzed. RESULTS Heart failure with PSF was present in 50.4% of patients with in-hospital assessment of left ventricular function. When compared with patients with systolic dysfunction, patients with PSF were more likely to be older, women, and hypertensive and less likely to have had a prior myocardial infarction or be receiving an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker. In-hospital mortality was lower in patients with PSF compared with patients with systolic dysfunction (2.8% vs. 3.9%; adjusted odds ratio [OR]: 0.86; p = 0.005), but duration of intensive care unit stay and total hospital length of stay were similar. Serum creatinine >2 mg/dl was associated with increased in-hospital mortality in both systolic function groups (PSF: 4.8%; systolic dysfunction: 8.4%; p < 0.0001), and the most powerful predictors of in-hospital mortality in both groups were blood urea nitrogen >37 mg/dl (OR: 2.53; 95% confidence interval [CI]: 2.22 to 2.87) and systolic blood pressure < or =125 mm Hg (OR: 2.58; 95% CI: 2.33 to 2.86). CONCLUSIONS Heart failure with PSF is common and is characterized by a unique patient profile. Event rates are worrisome and reflect a need for more effective management strategies.

Subfields: Cardiology and Cardiovascular Medicine, Endocrinology, Diabetes and Metabolism

View Paper: https://www.semanticscholar.org/paper/253648f7c01cab5d5f90e34d49a122684c09013a

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Citations in the corpus

Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. (2007, background): “etween acutely decompensated HF patients with and ithout PSF has been noted previously (2,18).”
Epidemiology of heart failure with preserved ejection fraction (2017, background): “Yancy et al.(35) 2001–2004 ADHERE hospitalization database ≥40 50.”
Epidemiology and clinical course of heart failure with preserved ejection fraction (2011, methodology): “This arrhythmia was found on the initial presenting ECG in 21% of acutely decompensated HFPEF patients in the ADHERE registry.(26)”
The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. (2014, background): “, 40% to 45%) and the population under consideration, 50% to 60% of the HHF population is classified as heart failure with reduced ejection fraction (HFrEF) (36).”
Epidemiology of Heart Failure (2013, methodology): “The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry used 40% as the cut point,(12) as did the Acute Decompensated Heart Failure National Registry (ADHERE) database.(22) The AHA and American College of Cardiology guidelines(23) rec”
Impact of Non-Cardiac Comorbidities on Morbidity and Mortality in a Predominantly Male Population with Heart Failure and Preserved versus Reduced Ejection Fraction (2012, background): “Most of the large published studies evaluating comorbidities in patients with HFpEF were based on hospitalized HF cohorts (1,2,4).”