Heart failure with preserved left ventricular systolic function: a hospital cohort study

Objective: To investigate how patients with heart failure with preserved left ventricular systolic function (LVSF) compare with patients with reduced LVSF. Design: Cohort study. Setting: Urban university hospital. Patients: 528 index emergency admissions with heart failure during the year 2000. Information on LVSF and follow up was available for 445 (84%) of these patients. Results: 130 (29%) patients had preserved LVSF ( defined as an ejection fraction. 40%). The median follow up was 814 days ( range 632 - 978 days). The average (SD) age was 72 ( 13) years. Women accounted for 62% and 45% of patients with preserved and reduced LVSF, respectively ( p = 0.001). Patients with preserved LVSF ( compared with those with reduced LVSF) had a higher prevalence of left ventricular hypertrophy (56% v 29%) and aortic valve disease ( mean gradient. 20 mm Hg; 31% v 9%). Fewer patients with preserved LVSF received an angiotensin converting enzyme inhibitor (65% v 78%, p = 0.008) or spironolactone (12% v 21%, p = 0.027). Anaemia tended to occur more often in patients with preserved LVSF than in those with reduced LVSF (43% v 33% for women, p = 0.12; 59% v 49% for men, p = 0.22). There was a similarly high prevalence of significant renal dysfunction in both groups ( estimated glomerular filtration rate < 60 ml/min/ 1.73 m(2) in 68% with preserved and 64% with reduced LVSF, p = 0.40). Mortality was similar in both groups ( preserved versus reduced 51 (39%) v 132 (42%), p = 0.51). Compared with patients with reduced LVSF, patients with preserved LVSF tended to have a lower risk of death or hospital admission for heart failure ( 56 ( 42%) v 165 (53%), p = 0.072) but a similar rate of death or readmission for any reason. Conclusion: Patients with preserved LVSF had more co-morbid problems than those with reduced LVSF; however, prognosis was similar for both groups.