Rehospitalization, mortality and associated variables in primary care patients with heart failure and preserved ejection fraction after first hospitalization

Abstract

Introduction

There is a paucity of studies providing insights into the progression of primary care patients with heart failure and preserved ejection fraction (HFpEF).

Objetive

To investigate the characteristics associated with mortality and rehospitalizations in primary care patients with heart failure and preserved ejection fraction (HFpEF), previously hospitalized.

Methods

Retrospective cohort study that included primary care patients with previous heart failure (HF) hospitalization and ejection fraction ≥50 of 328 primary care centers of Catalonia. Demographic, comorbidities, clinical, and treatment variables were collected. Outocomes: Mortality and HF rehospitalization. Adjusted Cox regression models were performed.

Results

Study included 2895 patients. Mean age was 77(SD 9.7) years, 57 % were female. Mean follow up was 2.0[1.0–9.0] years. A total of 864(29.8 %) patients died, 831(28.7 %) were hospitalized. Mortality was associated with male sex(HR 1.26, 95 % CI 1.06–1.49), age >75 years(HR 2.76, 95 % CI 2.24–3.39), Charlson Index(HR 2.03, 95 % CI 1.21–3.42), body mass index(BMI) ≤30 kg/m²(HR 1.44, 95 % CI 1.22–1.69) and loop diuretics(HR 1.36, 95 % CI 1.11–1.65); hemoglobin levels(HR 0.87, 95 % CI 95 % 0.82–0.91) were protective. HF rehospitalization was associated with male sex(HR 1.14, 95 % CI 1.03–1.33), age >75 years(HR 1.37, 95 % CI 1.17–1.61), atrial fibrillation(HR 1.44, 95 % CI 1.25–1.67), and loop diuretics(HR 1.37, 95 % CI 1.15–1.63). Hemoglobin(HR 0.91, 95 % CI 0.87–0.95) were protective.

Conclusion

High proportion of HFpEF patients were hospitalized or died at 5 years follow up. Comorbidities, demographic, analytical and treatment variables played a relevant role as prognostic factors.