Late mortality and determinants in patients with heart failure and preserved systolic left ventricular function: the Israel Nationwide Heart Failure Survey.
BACKGROUND
Heart failure with preserved systolic left ventricular function is a major cause of cardiac disability.


OBJECTIVE
To examine the prevalence, characteristics and late clinical outcome of patients hospitalized with HF-PSF on a nationwide basis in 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 > or = 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.
Lewis
Basil S
BS
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel. lewis@tx.technion.ac.il
Shotan
Avraham
A
Gottlieb
Shmuel
S
Behar
Shlomo
S
Halon
David A
DA
Boyko
Valentina
V
Leor
Jonathan
J
Grossman
Ehud
E
Zimlichman
Reuven
R
Porath
Avi
A
Mittelman
Moshe
M
Caspi
Abraham
A
Garty
Moshe
M
D000368:Aged; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007297:Inpatients; D007557:Israel / Q000453:epidemiology; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D011159:Population Surveillance; D011446:Prospective Studies; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends; D013599:Systole; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*