Clinical characteristics and prognosis of heart failure with normal left ventricular ejection fraction in elderly patients Full Text
Chinese Medical Journal, 08/21/2012
De–ping L et al. – More than half of elderly patients with heart failure (HF) have a normal LVEF. The prognosis of the elderly patients with heart failure with normal ejection fraction (HFNEF) is poor, though slightly better than the elderly patients with heart failure with reduced ejection fraction (HFREF).Methods
- Consecutive elderly patients (≥60 years old) hospitalized for the first episode of heart failure (HF) in Beijing Hospital from January 2003 to December 2009 were retrospectively recruited.
- 310 patients with HF were eligible for the study.
- As recently recommended, a cut–off value of 50% was used to distinguish HFNEF (LVEF ≥50%) from HFREF (LVEF<50%).
- Data were retrospectively obtained from hospital records and databases.
- Follow–up data were obtained by telephone and from hospital records.
- For every eligible patient, the clinical characteristics and prognosis were collected and compared between the HFNEF and HFREF groups.
- Patients with HFNEF accounted for 54.5% of all cases of elderly patients with HF.
- Compared with HFREF, the elderly patients with HFNEF had a higher proportion of females (62.1% vs. 32.6%, P <0.001), higher body mass index (BMI) ((24.9±4.7) vs. (23.5±4.0) kg/m2, P=0.011), higher systolic blood pressure at admission ((141.5±22.6) vs. (134.3±18.6) mmHg, P=0.002), but lower hemoglobin levels ((118.3±22.7) vs. (125.8±23.8) g/L, P=0.005).
- The incidence of coronary heart disease (43.2% vs. 65.2%, P <0.001) and myocardial infarction (16.6% vs. 46.1%, P <0.001) were significantly lower in elderly patients with HFNEF than in those with HFREF (P <0.001).
- With a mean follow–up of 33.5 (0.5–93) months, 120 patients (38.7%) died, including 94 (30.3%) cardiac deaths.
- The HFNEF group had fewer deaths than the HFREF group at the end of the first follow–up (46/169 (27.2%) vs. 58/141 (41.1%)) and at the end of the second follow–up (56/169 (33.1%) vs. 64/141 (45.4%)).
- Kaplan–Meier survival analysis showed a significantly higher survival rate in elderly patients with HFNEF than those with HFREF (P=0.021 for total mortality and P <0.001 for cardiac mortality).
- Multiple Logistic regression analysis showed that LVEF <50% was an independent risk factor for death in elderly patients with HF.