Clinical determinants and long-term survival in heart failure with supra-normal ejection fraction. Insights from LECRA-HF registry

Purpose

Heart failure with supra-normal ejection fraction (HFsnEF), defined as HF with left ventricular ejection fraction (LVEF) ​> ​65 ​%, constitutes a novel HF category. However, its clinical characteristics and long-term outcomes remain insufficiently elucidated. We sought to characterize Polish HFsnEF patients and provide their long-term mortality.

Material and methods

Of 1186 patients enrolled in the single-center Lesser Poland Cracovian Heart Failure (LECRA-HF) registry between years 2009 and 2019, 261 (22 ​%) were classified as HF with LVEF ≥50 ​%. Of them, 40 (15.3 ​%) were classified as HFsnEF, and the remaining 221 (84.7 ​%) as HF with preserved EF (HFpEF). Baseline characteristics, prior cardiovascular treatment, laboratory and echocardiographic measurements have been collected during index hospitalization. The long-term follow-up of all-cause mortality was obtained from the National Death Registry.

Results

HFsnEF patients were less frequently hypertensive (75 vs 88.2 ​%, P ​= ​0.026) and they were less often treated with mineralocorticoid receptor antagonists (25 vs 46.2 ​%, P ​= ​0.013) and loop diuretics (60 vs 76 ​%, P ​= ​0.017). The Kaplan-Meier analysis showed that all-cause mortality is higher in HFsnEF than in HFpEF (65 vs 55.2 ​%, P ​= ​0.044). The independent predictors of long-term mortality were age and HFsnEF diagnosis (hazard ratio [HR] 1.037, 95 ​% confidence interval [CI] 1.018–1.056; HR 1.665, 95 ​% CI 1.063–2.608, respectively).

Conclusions

Our findings indicate that every 7th Polish patient admitted with HFpEF could be classified as HFsnEF. Baseline characteristics of HFsnEF patients are not significantly different from HFpEF. Simultaneously, in the longest follow-up to date, HFsnEF diagnosis is associated with lower long-term survival.