Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee.
Quillen College of Medicine and Washington University of St. Louis, St. Louis, Missouri.
Am J Med Sci. 2020 Jun;359(6):325-333. doi: 10.1016/j.amjms.2020.03.008. Epub 2020 Mar 11.
Patients with left ventricular ejection fractions between 40% and 49% either discovered de novo, having declined from ≥50%, or improved from <40% have been described as heart failure (HF) with mid-range ejection fraction (HFmrEF). Though clinical signs and symptoms are similar to other phenotypes, possible prognostic differences and therapeutic responses reinforce the need for further understanding of patients' characteristics especially in a rural community based population. The purpose of this study is to evaluate the clinical characteristics, comorbidities and prognosis of a rural patient population with HFmrEF.
We queried the electronic medical record from a community based university practice for all patients with a HF diagnosis. We included only those patients with >3 months follow-up and interpretable Doppler echocardiograms. We recorded demographic, Doppler-echo, and outcome variables (up to 2,083 days).
There were 633 HF patients: 42.4% with preserved ejection fraction (HFpEF, EF ≥50%), 36.4% with HFmrEF, and 21.0% with reduced ejection fraction (HFrEF, EF <40%). HFmrEF patients were older, had greater coronary disease prevalence, lower systolic blood pressure, elevated brain natriuretic peptide, lower hemoglobin, and higher creatinine than HFpEF. All-cause mortality was intermediate between HFrEF and HFpEF but was not significantly different. Landmark analysis revealed a trend toward greater second readmission in HFmrEF as compared to HFpEF (hazard ratio: 1.43 [0.96-2.14],P = 0.0767).
Rural patients with HFmrEF without an ambulatory HF clinic represent a higher percentage of HF patients than previously reported with greater coronary disease prevalence with comparable readmission rates and nonsignificantly different all-cause mortality.
左心室射血分数在 40%至 49%之间的患者，无论是新发现的（从≥50%下降），还是从<40%改善的，均被描述为射血分数中间范围的心衰（HFmrEF）。虽然临床症状相似，但可能存在预后差异和治疗反应的不同，这强化了进一步了解患者特征的必要性，尤其是在农村社区人群中。本研究旨在评估农村 HFmrEF 患者的临床特征、合并症和预后。
我们查询了一个基于社区的大学实践的电子病历，以获取所有 HF 诊断患者的信息。我们仅纳入了那些有>3 个月随访且多普勒超声心动图可解释的患者。我们记录了人口统计学、多普勒超声心动图和结局变量（最多 2083 天）。
共有 633 名 HF 患者：42.4%为射血分数保留心衰（HFpEF，EF≥50%），36.4%为 HFmrEF，21.0%为射血分数降低心衰（HFrEF，EF<40%）。HFmrEF 患者年龄较大，冠心病患病率较高，收缩压较低，脑利钠肽升高，血红蛋白较低，肌酐较高，与 HFpEF 相比。HFmrEF 的全因死亡率在 HFrEF 和 HFpEF 之间居中，但无统计学差异。里程碑分析显示，HFmrEF 的再次入院率较 HFpEF 有升高趋势（风险比：1.43[0.96-2.14]，P=0.0767）。
没有门诊 HF 诊所的农村 HFmrEF 患者比之前报道的 HF 患者所占比例更高，冠心病患病率更高，但再入院率和全因死亡率无显著差异。
