Cardiology Letters 2012, 21(6):482-492

Do we know the situation of the patients hospitalized for acute heart failure with preserved ejection fraction in Slovakia?

Varga I¹, Líška B², Solík P¹, Luknár M¹, Babej Š¹, Lesný P¹

¹ Oddelenie zlyhávania a transplantácie srdca, Národný ústav srdcových a cievnych chorôb, a.s. v Bratislave, Slovenská republika

² Oddelenie intervenčnej kardiológie Kardiologickej kliniky, Klinikum Weiden, Spolková republika Nemecko

Background: Heart failure is the cardiovascular disorder that is still increasing in incidence and prevalence. Patients with acute heart failure (AHF) represent the subgroup at highest risk for growing in-hospital and postdischarge mortality. From one third to one half of them have a preserved left ventricular ejection fraction (LVEF). Purpose: To define and compare characteristics and outcomes between heart failure with preserved and reduced LVEF in a non-selected population of hospitalized AHF patients as well as to identify the parameters independently associated with heart failure with preserved ejection fraction (HFPEF).

Methods: We used the data from SLOVASeZ (Slovak Acute Heart Failure Survey), a nationwide multicenter AHF survey with 860 consecutive patients enrolled during 3 months (between 1 May 2009 and 31 July 2009) in 11 hospitals throughout Slovakia. Data were transferred from specific paper forms designed for this survey into an electronic database and statistically processed. HFPEF was defined as AHF with LVEF ≥ 50%. We analysed 73 variables from 601 patients with known LVEF in univariate analysis. Significant of these (p<0.05) were entered into linear regression model for multivariate analysis.

Results: Patients with HFPEF represent one third of the studied populations. Univariate analysis showed that they were older and mostly women (for both p<0.001). Hypertension (p<0.05) and valvular disease (p<0.01) were more frequent primary etiologies of HFPEF. Peripheral edema (p<0.05), high blood pressure (p<0.001), atrial flutter/fibrillation (p<0.01), interventricular septal hypertrophy (p<0.01) and renal dysfunction with creatinine >170 μmol/l (p<0.05) were more frequently diagnosed at admission among these patients. At discharge, HFPEF patients were more frequently treated by angiotensin receptor blockers (p<0.05), but on the other hand less by angiotensin-converting enzyme inhibitors (p<0.05), beta-blockers (p<0.01), aldosterone antagonists and digoxin (p<0.001 for both). There was no difference in in-hospital mortality or length of stay between both subgroups. Female gender and high blood pressure (p<0.01 for both), as well as atrial flutter/fibrillation (p<0.05) at admission, were independently associated with HFPEF in multivariate analysis.

Conclusion: Patients with HFPEF represent one third of the AHF population and have similar in-hospital mortality as well as lenght of stay as those with reduced LVEF. Female gender, hypertension and atrial flutter/ fibrillation are characteristics typically associated with HFPEF. Although the SLOVASeZ results are comparable with other surveys and registries, there is still need for better adherence to recommendations published in guidelines as well as creation of health care network (heart failure units) focused on these high-risk patients.

Keywords: acute heart failure; preserved ejection fraction; diagnostics; therapy; outcome; registry

Published: June 1, 2012  Show citation