1Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland; 2Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 3MediClin Herzzentrum Lahr/Baden Innere Medizin und Kardiologie Lahr/Schwarzwald, Deutschland
Objective: This study sought to determine the prognostic impact of acute decompensated heart failure (ADHF) in patients with heart failure with mildly reduced ejection fraction (HFmrEF).
Background: ADHF is a major complication in patients with heart failure (HF), however, the prognostic impact of ADHF in patients with HFmrEF has not yet been clarified.
Methods: Consecutive patients hospitalized with HFmrEF (i.e., left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) at one university medical center were retrospectively included from 2016 to 2022. The prognosis of patients with ADHF was compared to those without (i.e., non-ADHF). The primary endpoint was all-cause mortality at 30 months (median follow-up). Among others, secondary endpoints included in-hospital mortality as well as HF-related rehospitalization or major adverse cardiac or cerebrovascular events at 30 months. Kaplan-Meier, multivariable Cox proportional regression and propensity-score matched analyses were performed.
Results: 2184 patients with HFmrEF were included with a rate of ADHF of 22.2%. ADHF was associated with a significantly increased risk of all-cause mortality (50% vs 26%; HR = 2.269; 95% CI 1.939-2.656; p = 0.001) and HF-related rehospitalization at 30 months (27% vs. 10%; HR = 3.250; 95% CI 2.565 – 4.118; p = 0.001) which was still evident after multivariable adjustment and propensity-score matching. Subanalysis in the ADHF group demonstrated that previous ADHF during the 12 months prior to the index admission was associated with higher HF-related rehospitalization (41.7% vs. 23.0%; HR = 2.073; 95% CI 1.420 – 3.027; p = 0.001), but not all-cause mortality at 30 months (p = 0.264).
Conclusion: ADHF is common in HFmrEF and independently associated with 30-month all-cause mortality and HF-related rehospitalization.