Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry
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Aims: The objectives of the present study were to describe epidemiology and outcomes in ambulatory heart failure (HF) patients stratified by left ventricular ejection fraction (LVEF) and to identify predictors for mortality at 1 year in each group. Methods and results: The European Society of Cardiology Heart Failure Long-Term Registry is a prospective, observational study collecting epidemiological information and 1-year follow-up data in 9134 HF patients. Patients were classified according to baseline LVEF into HF with reduced EF [EF <40% (HFrEF)], mid-range EF [EF 40–50% (HFmrEF)] and preserved EF [EF >50% (HFpEF)]. In comparison with HFpEF subjects, patients with HFrEF were younger (64 years vs. 69 years), more commonly male (78% vs. 52%), more likely to have an ischaemic aetiology (49% vs. 24%) and left bundle branch block (24% vs. 9%), but less likely to have hypertension (56% vs. 67%) or atrial fibrillation (18% vs. 32%). The HFmrEF group resembled the HFrEF group in some features, including age, gender and ischaemic aetiology, but had less left ventricular and atrial dilation. Mortality at 1 year differed significantly between HFrEF and HFpEF (8.8% vs. 6.3%); HFmrEF patients experienced intermediate rates (7.6%). Age, New York Heart Association (NYHA) class III/IV status and chronic kidney disease predicted mortality in all LVEF groups. Low systolic blood pressure and high heart rate were predictors for mortality in HFrEF and HFmrEF. A lower body mass index was independently associated with mortality in HFrEF and HFpEF patients. Atrial fibrillation predicted mortality in HFpEF patients. Conclusions: Heart failure patients stratified according to different categories of LVEF represent diverse phenotypes of demography, clinical presentation, aetiology and outcomes at 1 year. Differences in predictors for mortality might improve risk stratification and management goals.
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A significant association exists between diabetes and a higher risk of adverse outcomes in patients with heart failure, with the greatest incremental risk associated with diabetes observed in patients with HFrEF.
“A significant association exists between diabetes and a higher risk of adverse outcomes in patients with HF, with the greatest incremental risk associated with diabetes observed in patients with HFrEF.467,[471][472][473][474][475]”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [471]
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- Authors
- Chioncel, O., Lainscak, M., Seferovic, P. M., Anker, S. D., Crespo-Leiro, M. G., Harjola, V.-P., Parissis, J., Laroche, C., Piepoli, M. F., Fonseca, C., Mebazaa, A., Lund, L., Ambrosio, G. A., Coats, A. J., Ferrari, R., Ruschitzka, F., Maggioni, A. P., & Filippatos, G.
- Affiliations
- Carol Davila University of Medicine and Pharmacy (RO)
- Department of Cardiology, General Hospital Celje
- University of Belgrade (RS)
- Universitätsmedizin Göttingen (DE)
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC , LaCoruna ,
- University of Helsinki (FI)
- University General Hospital Attikon (GR)
- EURObservational Research Programme, European Society of Cardiology , Sophia-Antipolis ,
- Azienda Unità Sanitaria Locale Piacenza (IT)
- Heart Failure Unit, S. Francisco Xavier Hospital, Centro Hospitalar Lisboa Ocidental. NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa
- Sorbonne Paris Cité (FR)
- Karolinska University Hospital (SE)
- University of Perugia (IT)
- University of Warwick (GB)
- University of Ferrara (IT)
- University of Zurich (CH)
- Associazione Nazionale Medici Cardiologi Ospedalieri (IT)
- National and Kapodistrian University of Athens (GR)
- Corresponding author
- Chioncel, Ovidiu
- ORCID
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-04-06
- Volume
- 19
- Issue
- 12
- Pages
- 1574-1585
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- OpenAlex
- W2617287176
- Cited by
- 927
- References
- 29
- Citations by year
- 2026: 76 · 2025: 115 · 2024: 139 · 2023: 134 · 2022: 118 · 2021: 107 · 2020: 89 · 2019: 65 · 2018: 68 · 2017: 15 · 2013: 1
- FWCI
- 50.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- RUC (Universidade Da Coruña) (acceptedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- ESC
- EURObservational Research Programme
- Abbott Vascular Int
- Amgen
- Bayer Pharma AG
- Boston Scientific International
- Bristol Myers Squibb and Pfizer alliance
- Boehringer Ingelheim
- Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company
- Menarini International Operations
- Novartis Pharma AG
- Merck & Co
- Sanofi-Aventis Group
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- chronic heart failure, left ventricular ejection fraction, heart failure with reduced ejection fraction, heart failure with preserved ejection fraction, heart failure with mildly reduced ejection fraction, one-year mortality, mortality risk factors, risk stratification, heart failure phenotypes, atrial fibrillation, chronic kidney disease, body mass index, systolic blood pressure, heart rate, left bundle branch block, NYHA functional class
- MeSH terms
- Aged, Cardiology, Cause of Death, Europe, Female, Follow-Up Studies, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Registries, Severity of Illness Index, Societies, Medical, Stroke Volume, Time Factors, Incidence, Ventricular Function, Left
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