Late mortality and determinants in patients with heart failure and preserved systolic left ventricular function: The Israel nationwide heart failure survey

Basil S. Lewis*, Avraham Shotan, Shmuel Gottlieb, Shlomo Behar, David A. Halon, Valentina Boyko, Jonathan Leor, Ehud Grossman, Reuven Zimlichman, Avi Porath, Moshe Mittelman, Abraham Caspi, Moshe Garty

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Heart failure with preserved systolic left ventricular function is a major cause of cardiac disability. Objectives: To examine the prevalence, characteristics and late clinical outcome of patients hospitalized with HF-PSF on a nationwide basisin Israel. Methods: The Israel nationwide HF survey examined prospectively 4102 consecutive HF patients admitted to 93 internal medicine and 24 cardiology departments in all 25 public hospitals in the country. Echocardiographic LV function measurements were available in 2845 patients (69%). The present report relates to the 1364 patients who had HF-PSF (LV ejection fraction ≥ 40%). Results: Mortality of HF-PSF patients was high (in-hospital 3.5%, 6 months 14.2%, 12 months 22.0%), but lower than in patients with reduced systolic function (all P < 0.01). Mortality was higher in patients with HF as the primary hospitalization diagnosis (16.0% vs. 12.5% at 6 months, P = 0.07 and 26.2% vs. 18.0% at 12 months, P = 0.0002). Patients with HF-PSF who died were older (78 ± 10 vs. 71 ± 12 years, P < 0.001), more often female (P = 0.05) and had atrial fibrillation more frequently (44% vs. 33%, P < 0.01). There was also a relationship between mortality and pharmacotherapy: after adjustment for age and co-morbid conditions, mortality was lower in patients treated with angiotensin-converting enzyme inhibitors (P = 0.0003) and angiotensin receptor blockers (P = 0.002) and higher in those receiving digoxin (P = 0.003) and diuretic therapy (P = 0.009). Conclusions: This nationwide survey highlights the very high late mortality rates in patients hospitalized for HF without a decrease in systolic function. The findings mandate a focus on better evidence-based treatment strategies to improve outcome in HF-PSF patients.

Original languageEnglish
Pages (from-to)234-238
Number of pages5
JournalIsrael Medical Association Journal
Volume9
Issue number4
StatePublished - Apr 2007

Keywords

  • Diastolic dysfunction
  • Hearth failure
  • Mortality
  • Pharmacotherapy

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