or Death in Patients With Versus Without Preserved Left Ventricular Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) is recognized as a major cause of cardiovascular morbidity and mortality. An ability to identify patients with HFpEF who are at increased risk for adverse outcomes can facilitate their more careful management. We studied the patients having heart failure (HF) using data from the Heart Failure Adherence and Retention Trial (HART). HART enrolled 902 patients in the New York Heart Association (NYHA) class II or III who had been recently hospitalized for HF to study the impact of self-management counseling on the primary outcome of death or HF hospitalization. In HART, 208 patients had HFpEF and 692 had HF with reduced ejection fraction (HFrEF) and were followed for a median of 1,080 days. Two final multivariate models were developed. In patients having HFpEF, predictors of primary outcome were male gender (odds ratio [OR] 3.45, p [ 0.004), NYHA class III (OR 3.05, p [ 0.008), distance covered on a 6-minute walk test (6-MWT) of 65 years (OR 1.63, p [ 0.01). In conclusion, indicators of functional status (6-MWT and NYHA class) were common to both patients with HFpEF and those with HFrEF, whereas gender and adherence to prescribed therapy were unique to patients having HFpEF in predicting death or HF hospitalization. 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;112:1907e1912) Given the increasing recognition of heart failure with preserved ejection fraction (HFpEF) as a growing and difficult-to-treat clinical problem, the identification of predictors of adverse outcomes can help to identify those patients who are at the highest risk and who would benefit from more personalized and aggressive management. To be useful, such predictors should be easy to identify in routine clinical practice, thereby making them potentially valuable in personalizing the approach to patient care, monitoring disease progression, and evaluating therapeutic effectiveness. Comparing these predictors among patients having HFpEF and those having heart failure with reduced ejection fraction (HFrEF) can further our understanding of the differences in the 2 subtypes of heart failure (HF). Methods