title: Predictors of two-year mortality in Asian patients with heart failure and preserved ejection fraction.
abstract: BACKGROUND
  Mortality in patients with heart failure and preserved ejection fraction (HFpEF) remains high. Data from Asia is lacking. We aim to study the impact of ethnicity and other predictors of mortality in patients admitted for HFpEF in a multi-ethnic Asian country.
  
  
  METHODS
  Consecutive patients admitted to two local institutions with heart failure and ejection fraction ≥50% on transthoracic echocardiogram from Jan 2008 to Dec 2009 were included. All patients were followed-up for 2 years. Overall mortality was obtained from the national registry of deaths in our country.
  
  
  RESULTS
  A total of 1960 patients with heart failure were included. 751 (38.3%) patients had HFpEF. Overall mortality at two years was 26.6% (n=200) compared to 37.1% (n=449) in patients with reduced ejection fraction (HR 0.618 (95% CI 0.508-0.753), p<0.001). Ethnicity did not predict mortality. On multivariable Cox regression analysis, significant predictors of two-year mortality in HFpEF patients were older age (HR 1.027 (1.011-1.044)), prior myocardial infarction (HR 1.577 (1.104-2.253)), prior stroke (HR 1.475 (1.055-2.061)), smoking (HR 1.467 (1.085-1.985)), higher creatinine levels (HR 1.002 (1.001-1.003)) and use of mineralocorticoid receptor antagonists (HR 1.884 (1.226-2.896)). Use of warfarin (HR 0.506 (0.304-0.842)) and statins (HR 0.585 (0.435-0.785)) were associated with significantly lower mortality.
  
  
  CONCLUSIONS
  In our Asian population presenting with HFpEF, two-year mortality was 26.6%. Ethnicity did not predict mortality. Older age, prior myocardial infarction, prior stroke, smoking, and higher creatinine levels were found to be significant predictors of mortality.
authors: Department of Cardiology, National Heart Centre Singapore, Singapore.
authors: Jonathan
authors: J
authors: Yap
authors: Department of Cardiology, National Heart Centre Singapore, Singapore.
authors: David
authors: D
authors: Sim
authors: Department of Cardiology, National Heart Centre Singapore, Singapore.
authors: Choon Pin
authors: CP
authors: Lim
authors: Department of Cardiology, National Heart Centre Singapore, Singapore.
authors: Shaw Yang
authors: SY
authors: Chia
authors: Department of Cardiology, National Heart Centre Singapore, Singapore.
authors: Yun Yun
authors: YY
authors: Go
authors: Department of Internal Medicine, Singapore General Hospital, Singapore.
authors: Fazlur Rehman
authors: FR
authors: Jaufeerally
authors: Department of Cardiology, National Heart Centre Singapore, Singapore.
authors: Ling Ling
authors: LL
authors: Sim
authors: Duke-NUS Graduate Medical School, Singapore.
authors: Reginald
authors: R
authors: Liew
authors: Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Graduate Medical School, Singapore. Electronic address: ching.chi.keong@nhcs.com.sg.
authors: Chi-Keong
authors: CK
authors: Ching
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000208:ethnology; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000208:ethnology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology*
keywords: Ethnicity; Heart failure; Mortality; Preserved ejection fraction