Acute heart failure (AHF) with preserved left ventricular ejection fraction (PLVEF)
represents a significant part of AHF syndromes featuring particular characteristics.
We sought to determine the clinical profile and predictors of in-hospital mortality
in patients with AHF and PLVEF in the Acute Heart Failure Global Survey of Standard
Treatment (ALARM-HF). This survey is an international observational study of 4,953
patients admitted for AHF in 9 countries (6 European countries, Mexico, and Australia)
from October 2006 to March 2007. Patients with PLVEF were defined by an LVEF ≥45%.
Of the total cohort, 25% of patients had PLVEF. In-hospital mortality was significantly
lower in this subgroup (7% vs 11% in patients with decreased LVEF, p = 0.013). Candidate
variables included demographics, baseline clinical findings, and treatment. Multivariate
logistic regression analysis showed that the variables independently associated with
in-hospital mortality included systolic blood pressure at admission (p <0.001), serum
sodium (p = 0.041), positive troponin result (p = 0.023), serum creatinine >2 mg/dl
(p = 0.042), history of peripheral vascular disease and anemia (p = 0.004 and p =
0.015, respectively), secondary (hospitalization for other reason) versus primary
AHF diagnosis (p = 0.043), and previous treatment with diuretics (p = 0.023) and angiotensin-converting
enzyme inhibitors (p = 0.021). In conclusion, patients with AHF and PLVEF have lower
in-hospital mortality than those with decreased LVEF. Low systolic blood pressure,
low serum sodium, renal dysfunction, positive markers of myocardial injury, presence
of co-morbidities such as peripheral vascular disease and anemia, secondary versus
primary AHF diagnosis, and absence of treatment with diuretics and angiotensin-converting
enzyme inhibitors at admission may identify high-risk patients with AHF and PLVEF.
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Article Info
Publication History
Accepted:
August 11,
2010
Received in revised form:
August 11,
2010
Received:
July 3,
2010
Footnotes
The ALARM-HF survey was funded by Abbott , Chicago, Illinois, and data were acquired by IMS, London, United Kingdom.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
