Journal
CIRCULATION
Volume 126, Issue 1, Pages 65-+Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCULATIONAHA.111.080770
Keywords
cardiomyopathies; epidemiology; heart failure; outcome assessment (health care)
Funding
- American Heart Association
- Medtronic
- GlaxoSmithKline
- Ortho-McNeil
- American Heart Association Pharmaceutical Roundtable
- Amarin
- AstraZeneca
- Bristol-Myers Squibb
- Eisai
- Ethicon
- Sanofi Aventis
- The Medicines Company
- FlowCo
- PLx Pharma
- Takeda
- Accumetrics
- Intekrin Therapeutics
- Merck
- Johnson Johnson
- Amylin
- Proventys
- National Heart, Lung, and Blood Institute
- Novartis
- Pfizer
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Background-Heart failure with preserved ejection fraction (EF) is a common syndrome, but trends in treatments and outcomes are lacking. Methods and Results-We analyzed data from 275 hospitals in Get With the Guidelines-Heart Failure from January 2005 to October 2010. Patients were stratified by EF as reduced EF (EF <40% [HF-reduced EF]), borderline EF (40%<= EF<50% [HF-borderline EF]), or preserved (EF >= 50% [HF-preserved EF]). Using multivariable models, we examined trends in therapies and outcomes. Among 110 621 patients, 50% (55 083) had HF-reduced EF, 14% (15 184) had HF-borderline EF, and 36% (40 354) had HF-preserved EF. From 2005 to 2010, the proportion of hospitalizations for HF-preserved EF increased from 33% to 39% (P < 0.0001). In multivariable analyses, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at discharge decreased in all EF groups, and beta-blocker use increased. Patients with HF-preserved EF less frequently achieved blood pressure control (adjusted odds ratio, 0.44 versus HF-reduced EF; P < 0.001) and were more likely discharged to skilled nursing (adjusted odds ratio, 1.16 versus HF-reduced EF; P < 0.001). In-hospital mortality for HF-preserved EF decreased from 3.32% in 2005 to 2.35% in 2010 (adjusted odds ratio, 0.89 per year; P = 0.01) but was stable for patients with HF-reduced EF (3.03%-2.83%; adjusted odds ratio, 0.93 per year; P = 0.10). Conclusions-Hospitalization for HF-preserved EF is increasing relative to HF-reduced EF. Although in-hospital mortality for patients with HF-preserved EF declined over the study period, an important opportunity remains for identifying evidence-based therapies in patients with HF-preserved EF. (Circulation. 2012; 126: 65-75.)
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