Objective: Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF). Methods: We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50% at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50% at admission and < 50% at 1 year), and persistent HFpEF (LVEF ≥ 50% both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis. Results: Of patients with HFpEF, 426 (90.4%) were diagnosed as having persistent HFpEF and 45 (9.6%) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95% confidence interval [CI]: 1.42–7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95% CI 1.13–2.96, P = 0.015). The use of beta-blockers, renin–angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF. Conclusions: HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients. Clinical trial registration: ClinicalTrial.gov identifier: NCT01389843. URL: https://clinicaltrials.gov/ct2/show/NCT01389843.
Bibliographical noteFunding Information:
The Korean Acute Heart Failure Registry study was conducted in ten tertiary medical centers: Seoul National University Hospital, Seoul, Korea; Sungkyunkwan University College of Medicine, Seoul, Korea; University of Ulsan College of Medicine, Seoul, Korea; Chungbuk National University College of Medicine, Cheongju, Korea; Kyungpook National University College of Medicine, Daegu, Korea; the Catholic University of Korea, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Yonsei University Wonju College of Medicine, Wonju, Korea; Seoul National University Bundang Hospital, Seongnam, Korea; and Heart Research Center of Chonnam National University, Gwangju, Korea.
This work was supported by Research of Korea Centers for Disease Control and Prevention (2010-E63003-00, 2011-E63002-00, 2012-E63005-00, 2013-E63003-00, 2013-E63003-01, 2013-E63003-02, and 2016-ER6303-00) and by the SNUBH Research Fund (Grant nos. 14-2015-029, 16-2017-003).
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine