To determine short-term outcomes after an episode of acute heart failure in patients
with mid-range ejection fraction (40%–49%; HFmrEF) compared with patients with reduced
(<40%) and preserved (>49%) ejection fractions (HFrEF and HFpEF, respectively) and
according to their final destination after emergency department (ED) care. This is
an exploratory, secondary analysis of the Epidemiology of Acute Heart Failure in the
Emergency departments Registry, which includes consecutive acute heart failure patients
diagnosed in 41 Spanish EDs. Patients with echocardiography data were included and
divided into HFrEF, HFmrEF, and HFpEF. The primary outcome was 30-day all-cause mortality,
and secondary outcomes were in-hospital all-cause mortality, hospital length of stay
>10 days, and 30-day postdischarge ED revisit due to AHF and combined end point (ED
revisit and/or death). We included 6,856 patients (age 79 [10]; 52.1% women): 21.6%
had HFrEF, 14.3% HFmrEF, and 64.1% HFpEF. The main destinations for the 982 HFmrEF
patients after ED management were internal medicine (293, 29.8%), cardiology (194,
19.9%) and not hospitalized (241, 24.5%), whereas the remaining 254 patients were
admitted to other departments, including geriatric wards, short-stay units and intensive
care units. Outcomes for HFmrEF did not differ compared with either HFrEF or HFpEF.
Compared with HFmrEF admitted to cardiology, internal medicine admission or direct
ED discharge increased the 30-day postdischarge ED revisit (hazard ratio [HR] 1.713,
95% confidence interval [CI] 1.042 to 2.816; and HR 1.683, 95% CI 1.046 to 2.708,
respectively) and the 30-day postdischarge combined end point (HR 1.732, 95% CI 1.070
to 2.803; and HR 1.727, 95% CI 1.083 to 2.756, respectively). In conclusion, patients
in the newly created HFmrEF category suffering from an acute decompensation have similar
short-term outcomes as those in the classical HFrEF and HFpEF categories; nonetheless,
HFmrEF patients handled in cardiology wards during decompensation obtain better outcomes,
and reasons for these differences have to be unmasked and corrected.
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Article info
Publication history
Published online: September 26, 2018
Accepted:
September 17,
2018
Received in revised form:
September 8,
2018
Received:
July 17,
2018
Footnotes
Funding: This study was partially supported by grants from the Instituto de Salud Carlos III supported with funds from the Spanish Ministry of Health and FEDER (PI15/01019 and PI15/00773) and Fundació La Marató de TV3 (2015/2510). The “Emergencies: Processes and Pathologies” research group of the IDIBAPS receives financial support from the Catalonian Government for Consolidated Groups of Investigation (GRC 2009/1385 and 2014/0313).
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