Department of Heart Failure and Transplantology, National Institute of Cardiology, Warsaw, Poland.
Agency for Health Technology Assessment and Tariff System, Warsaw, Poland
Pol Arch Intern Med. 2023 Dec 21;133(12). doi: 10.20452/pamw.16522. Epub 2023 Jun 30.
Recently, a stratification of the heart failure (HF) phenotypes, which classifies HF into 3 subtypes based on ejection fraction, has been introduced. Before that, clinical trials and registries have been mainly devoted to HF with reduced ejection fraction (HFrEF). As a result, data on long‑term survival trends for individual HF phenotypes are scarce.
The study aimed to evaluate survival according to the HF phenotype and to identify predictors of mortality.
Patients hospitalized for HF in our referral center between January 2014 and May 2019 were included in the analysis. HF phenotyping was based on EF: reduced (HFrEF with EF <40%), mildly reduced (HFmrEF with EF = 40%-49%), and preserved (HFpEF with EF ≥50%).
Of 2601 patients included in the study, 1608 individuals (62%) presented with HFrEF, 331 patients with HFmrEF (13%), and 662 patients with HFpEF (25%). The median follow‑up was 2.43 years (interquartile range, 1.56-3.49). The risk of death was 61% higher in HFrEF than in HFpEF (P <0.001), while in HFmrEF and HFpEF it was similar. Survival rates at 1 and 5 years in HFrEF, HFmrEF, and HFpEF were 81%, 84%, 84%, and 47%, 61%, and 59%, respectively. The HF phenotypes differed in most of the parameters that affect prognosis. Only the use of inotropes, which was linked to an increased risk of death, and the use of angiotensin‑converting enzyme inhibitors, which reduced this risk, were independent of the HF phenotype.
Survival in HFrEF is worse as compared with HFmrEF and HFpEF, where it is similar. The HF phenotypes differ in most of the parameters that affect survival.
最近，心力衰竭（HF）表型进行了分层，根据射血分数将 HF 分为 3 种亚型。在此之前，临床试验和注册研究主要针对射血分数降低的心力衰竭（HFrEF）。因此，关于各个 HF 表型的长期生存趋势的数据很少。
本研究旨在评估根据 HF 表型的生存率，并确定死亡率的预测因素。
我们纳入了 2014 年 1 月至 2019 年 5 月在我们的转诊中心因 HF 住院的患者进行分析。HF 表型基于 EF：射血分数降低（HFrEF，EF<40%）、轻度降低（HFmrEF，EF=40%-49%）和保留（HFpEF，EF≥50%）。
在纳入研究的 2601 例患者中，1608 例（62%）为 HFrEF，331 例（13%）为 HFmrEF，662 例（25%）为 HFpEF。中位随访时间为 2.43 年（四分位距，1.56-3.49）。HFrEF 的死亡风险比 HFpEF 高 61%（P<0.001），而 HFmrEF 与 HFpEF 之间相似。HFrEF、HFmrEF 和 HFpEF 的 1 年和 5 年生存率分别为 81%、84%、84%和 47%、61%和 59%。HF 表型在影响预后的大多数参数上存在差异。只有正性肌力药物的使用，这与死亡风险增加有关，以及血管紧张素转换酶抑制剂的使用，这降低了这种风险，与 HF 表型无关。
与 HFmrEF 和 HFpEF 相比，HFrEF 的生存率更差，而 HFmrEF 和 HFpEF 之间相似。HF 表型在影响生存的大多数参数上存在差异。
