Incident cases of heart failure in a community cohort: importance and outcomes of patients with preserved systolic function

Background The clinical presentation and outcomes of patients with heart failure and preserved systolic function have not been well characterized in the outpatient setting. Methods This was a retrospective cohort study of 403 patients with new-onset heart failure in a large regional health maintenance organization between July 1996 and December 1996. The clinical characteristics and treatment of patients with preserved ejection fractions (PrEF; >45%) were compared with those of patients with with reduced left ventricular function (Low EF) after excluding patients with terminal comorbidities. The main outcome measure was the combination of death, cardiovascular (CV) hospitalization, or both, which was assessed for as long as 24 months (mean, 22 months) with proportional hazards models. Results Sixty-five patients (16%) did not have an assessment of left ventricular (LV) function. Of the remaining 338 patients, 191(57%) had an EF <45% (Low EF group) and 147 (44%) had preserved LV function (PrEF group). Patients with PrEF tended to be older, more frequently women, have less coronary disease and myocardial infarction, and have more atrial fibrillation and other comorbid conditions. They had higher systolic blood pressures and pulse pressures and slower heart rates than the patients with reduced LV function on initial presentation. Overall, mortality and CV hospitalization rates were similar in the 2 groups; however, on multivariate analysis, which took into account baseline differences between groups, low EF was a significant independent predictor of the combined end point (hazard ratio, 1.9; 95% CI, 1.3-2.9). Conclusions Patients with preserved LV function constitute a significant portion of incident outpatient patients with heart failure and carry a better prognosis than patients with reduced LV function.