An Overview of HFpEF Characteristics, Treatment Patterns, & Outcomes, with Stephen Greene, MD

Article

An analysis of more than 45,000 patients with heart failure with preserved ejection fraction (HFpEF) provides clinicians with a snapshot of the patient and clinical characteristics among this patient population in the US.

Presented by Stephen Greene, MD, of Duke University School of Medicine, at the European Society of Cardiology (ESC) Congress 2022, results of the study, which was an analysis of Humedica EMR data from 2010-2020, provide an overview of patient characteristics, treatment patterns, and clinical outcomes across the range of ejection fraction among patients hospitalized with HFpEF.

Designed by Greene and a team of colleagues from St. Luke’s Mid America Heart Institute and Bristol Myers Squibb, the current study was launched with an interest in describing the current landscape of HFpEF in the US. Using Humedica EMR data recorded between January 2010-December 2020, investigators sought to identify patients hospitalized with a primary diagnosis of heart failure and an ejection fraction greater than 40% who were considered hemodynamically stable at admission, without concurrent acute coronary syndrome or end­stage renal disease, and treated with IV diuretic agents within 48 hours of admission. Using this criterion, investigators identified 47,026 individuals for inclusion in their analyses. Using these patients, investigators planned analyses to compare patient characteristics, treatment patterns, and clinical outcomes of these individuals according to ejection fraction range, with ejection fraction ranges defined as 41-49%, 50-59%, and 60% or greater.

Of the 47,026 included in the trial, 13% (n=6335) had an ejection fraction of 41-49%, 40% (n=18,603) had an ejection of 50-59%, and 47% (n=22,088) had an ejection fraction of 60% or greater. Investigators noted the patient characteristics were similar across all 3 groups of ejection fraction ranges, with a median age of 77 years across all 3 groups, the proportion of patients identifying as White ranged from 83-84%, the proportion of patients identifying as Black ranged from 12-13%, median systolic blood pressure ranged from 137-138 mmHg at admission, and median eGFR ranged from 63-64 ml/min/1.73m2 at admission cross the ejection fraction groups.

However, investigators pointed out that, as ejection fraction increased, the proportion of women increased while the median NT-proBNP levels decreased. The lowest rates of coronary artery disease and atrial fibrillation as well as the highest rates of chronic pulmonary disease were observed among those with an ejection fraction of 60% or greater, according to investigators.

With an interest in learning more about the study and potential prescribing practices among this patient population, PracticalCardiology reached out to Greene, who also serves as an editorial advisory board member for PracticalCardiology, and that conversation is the subject of the following ESC 22 House Call.

This study, “Heart failure across the range of preserved ejection fraction in United States clinical practice,” was presented at ESC Congress 2022.

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