title: In-hospital and 1-year outcomes of acute heart failure patients according to presentation (de novo vs. worsening) and ejection fraction. Results from IN-HF Outcome Registry.
abstract: BACKGROUND
  To investigate the outcomes of hospitalized patients with both de-novo and worsening heart failure (HF) with preserved left ventricular ejection fraction (LVEF) (HFpEF) (LVEF ≥ 50%), compared to those with reduced LVEF (HFrEF).
  
  
  RESULTS
  We studied 1669 patients (22.6% HFpEF) hospitalized for acute HF in the prospective multi-center nationwide Italian Network on Heart Failure (IN-HF) Outcome Registry. In all patients LVEF was assessed during hospitalization. De-novo HF presentations constituted 49.6% of HFpEF and 43.1% of HFrEF hospitalizations. All-cause mortality during hospitalization was lower in HFpEF than HFrEF (2.9% vs 6.5%, p=0.01), but this mortality difference was not significant at 1 year (19.6% vs 24.4%, p=0.06), even after adjusting for clinical covariates. Similarly, there were no differences in 1-year mortality between HFpEF and HFrEF when compared by cause of death (cardiovascular vs non-cardiovascular) or mode of presentation (worsening HF vs de novo). Rehospitalization rates (all-cause, non-cardiovascular, cardiovascular, HF-related) at 90 days and 1 year were also similar. Mode of presentation influenced rehospitalizations in HFpEF, where those presenting with worsening HFpEF had higher all-cause (36.8% vs 21.6%, p=0.001), cardiovascular (28.1% vs 14.9%, p=0.002), and HF-related (21.1% vs 7.7%, p=0.0003) rehospitalization rates at 1 year compared to those with de novo presentations.
  
  
  CONCLUSIONS
  Outcomes at 1 year following hospitalization for HFpEF are as poor as that of HFrEF. A prior history of HF decompensation or hospitalization identifies patients with HFpEF at particularly high risk of recurrent events. These findings may have implications for clinical practice, quality and process improvements and trial design.
authors.affiliation: Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.affiliation: Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Gavazzi
authors.affiliation: Cardiologia 2 Heart Failure and Heart Transplant Program, "A. De Gasperis" Cardiovascular Dept., Niguarda Hospital, Milano, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Oliva
authors.affiliation: Dept. of Clinical Cardiology and Heart Failure, Policlinico di Monza, Monza, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mortara
authors.affiliation: ANMCO Research Center, Firenze, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Urso
authors.affiliation: Maria Cecilia Hospital - GVM Care & Research - E.S. Health Science Foundation, Cotignola, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Pozzoli
authors.affiliation: Cardiology, University and Spedali Civili, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: ANMCO Research Center, Firenze, Italy.
authors.forename: Donata
authors.initials: D
authors.lastname: Lucci
authors.affiliation: ANMCO Research Center, Firenze, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Gonzini
authors.affiliation: Cardiology-ICU Dept., AOR Villa Sofia-Cervello PO Villa Sofia, Palermo, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cirrincione
authors.affiliation: Cardiology Dept., Ospedale San Luigi Gonzaga, Orbassano, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Montagna
authors.affiliation: Cardiovascular Unit, Azienda Servizi Sanitari n. 1 Triestina, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: ANMCO Research Center, Firenze, Italy. Electronic address: centrostudi@anmco.it.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Maria Cecilia Hospital - GVM Care & Research - E.S. Health Science Foundation, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D013318:Stroke Volume / Q000502:physiology*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists
keywords: Acute heart failure; Heart failure with preserved ejection fraction; Prognosis; Registry