Outcome of Heart Failure with Preserved Ejection Fraction in a Population-Based Study
R. Sacha Bhatia, M.D., M.B.A., Jack V. Tu, M.D., Ph.D., Douglas S. Lee, M.D., Ph.D., Peter C. Austin, Ph.D., Jiming Fang, Ph.D., Annick Haouzi, M.D., Yanyan Gong, M.Sc., and Peter P. Liu, M.D.
Background The importance of heart failure with preserved ejectionfraction is increasingly recognized. We conducted a study toevaluate the epidemiologic features and outcomes of patientswith heart failure with preserved ejection fraction and to comparethe findings with those from patients who had heart failurewith reduced ejection fraction.
Methods From April 1, 1999, through March 31, 2001, we studied2802 patients admitted to 103 hospitals in the province of Ontario,Canada, with a discharge diagnosis of heart failure whose ejectionfraction had also been assessed. The patients were categorizedin three groups: those with an ejection fraction of less than40 percent (heart failure with reduced ejection fraction), thosewith an ejection fraction of 40 to 50 percent (heart failurewith borderline ejection fraction), and those with an ejectionfraction of more than 50 percent (heart failure with preservedejection fraction). Two groups were studied in detail: thosewith an ejection fraction of less than 40 percent and thosewith an ejection fraction of more than 50 percent. The mainoutcome measures were death within one year and readmissionto the hospital for heart failure.
Results Thirty-one percent of the patients had an ejection fractionof more than 50 percent. Patients with heart failure with preservedejection fraction were more likely to be older and female andto have a history of hypertension and atrial fibrillation. Thepresenting history and clinical examination findings were similarfor the two groups. The unadjusted mortality rates for patientswith an ejection fraction of more than 50 percent were not significantlydifferent from those for patients with an ejection fractionof less than 40 percent at 30 days (5 percent vs. 7 percent,P=0.08) and at 1 year (22 percent vs. 26 percent, P=0.07); theadjusted one-year mortality rates were also not significantlydifferent in the two groups (hazard ratio, 1.13; 95 percentconfidence interval, 0.94 to 1.36; P=0.18). The rates of readmissionfor heart failure and of in-hospital complications did not differbetween the two groups.
Conclusions Among patients presenting with new-onset heart failure,a substantial proportion had an ejection fraction of more than50 percent. The survival of patients with heart failure withpreserved ejection fraction was similar to that of patientswith reduced ejection fraction.
Source Information
From the Heart & Stroke/Richard Lewar Centre of Excellence, University of Toronto, and the Division of Cardiology, Toronto General Hospital, University Health Network (R.S.B., J.V.T., D.S.L., A.H., P.P.L.); the Division of General Internal Medicine, Sunnybrook and Women's College Health Sciences Centre, University of Toronto (R.S.B., J.V.T.); and the Institute for Clinical Evaluative Sciences (J.V.T., D.S.L., P.C.A., J.F., Y.G.) — all in Toronto; and the National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, Mass. (D.S.L.). Drs. Tu and Liu contributed equally to this article.
Address reprint requests to Dr. Liu at the Heart & Stroke/Richard Lewar Centre of Excellence, NCSB 11-1266, Toronto General Hospital, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada, or at peter.liu{at}utoronto.ca.
Heart Failure with Preserved Ejection Fraction
Fiack C. A., Farber H. W., Arias M. A., Alonso-Fernández A., García-Río F., Kessler K. M., Ahmed A., Fleg J. L., Gheorghiade M., Owan T. E., Redfield M. M., Liu P. P., Lee D. S., Tu J. V., Ph.D. M.D.
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N Engl J Med 2006;
355:1828-1831, Oct 26, 2006.
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