Prognostic impact of acute decompensated heart failure in patients with heart failure and mildly reduced ejection fraction

Tobias Schupp (Mannheim)1, A. Schmitt (Mannheim)1, M. Reinhardt (Mannheim)1, N. Abel (Mannheim)1, J. Forner (Mannheim)1, M. Ayoub (Bad Oeynhausen)2, K. A. Mashayekhi (Lahr/Schwarzwald)3, I. Akin (Mannheim)1, M. Behnes (Mannheim)1

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.

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