065 Factors that precipitate hospitalizations for heart failure with preserved ejection fraction – characteristics and impact on post-discharge outcome

Background Hospitalizations for heart failure (HF) are associated with high mortality and influence post-discharge survival in patients with both reduced and preserved (≥50%) ejection fraction (EF). Several factors may precipitate HF hospitalizations. Heart failure with preserved ejection fraction (HFPEF) is associated with considerable mortality. The characteristics and prognostic impact of precipitating factors have not been studied in patients with HFPEF. Aims To study the characteristics and impact on long-term outcome of HF precipitating factors in patients surviving a first hospitalization for HFPEF. Methods We conducted a prospective observational study (11 healthcare establishments, Somme, France) and included consecutive patients discharged alive after a first hospitalization for HFPEF. Precipitating factors were collected on admission (acute coronary syndromes [ACS], uncontrolled hypertension, arrhythmia, worsening of renal function [WRF], non-adherence to therapy, and pneumonia). Mortality analyses used Cox models. Patients were followed for 5 years. Results The cohort comprised 358 patients (76±10 years, 53% women). Mean EF was 63±8%. One ore more precipitating factors were identified in 274 patients (76%). The most common were arrhythmia (37%), pneumonia (16%), ACS (12%), and WRF (12%). Uncontrolled hypertension and non-adherence to therapy were identified in 9% and 10% of cases, respectively. Arrhythmia (HR1.35[1.02-1.80];p=0.03) and pneumonia (HR1.44[1.01-2.07];p=0.05) were independently related to increased 5-year mortality. Compared to patients without precipitating factors (n=84), those with one factor (n=190; HR 1.67[1.15-2.43];p=0.007) as well as those with ≥2 factors (n=84; HR 1.59[1.03-2.45];p=0.04) displayed excess 5-year mortality. Conclusion Factors that precipitate hospitalizations are frequent among patients with HFPEF and predict increased long-term mortality. A more attentive management of these factors may translate into survival benefits.