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Cited by 927Heart Failure Treatment and ManagementCardiovascular Function and Risk FactorsTakotsubo Cardiomyopathy and Associated Phenomena

Clinical Presentation, Management, and In-Hospital Outcomes of Patients Admitted With Acute Decompensated Heart Failure With Preserved Systolic Function

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Yancy, Clyde W., Lopatin, Margarita, Stevenson, Lynne Warner, De Marco, Teresa, Fonarow, Gregg C.·2006·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2005.09.022
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Abstract

Unlabelled Approximately 50% of patients hospitalized for heart failure have preserved systolic function. These patients are more likely to be older, women, and hypertensive. Their duration of hospitalization is similar to that of heart failure patients with systolic dysfunction, but their in-hospital mortality risk is lower. This mortality risk is increased in the setting of renal insufficiency, and the two most important risk predictors are elevated blood urea nitrogen and systolic blood pressure < or = 125 mm Hg. Medical treatment strategies for patients with preserved systolic function are inconsistent and reflect the need for efficacious evidence-based treatment regimens.Objectives The aims of this analysis were to describe the clinical characteristics, management, and outcomes of patients hospitalized for acute decompensated heart failure (HF) with preserved systolic function (PSF).Background Clinically meaningful characteristics of these patients have not been fully studied in a large database.Methods Data from >100,000 hospitalizations from the Acute Decompensated Heart Failure National Registry (ADHERE) database were analyzed.Results Heart failure with PSF was present in 50.4% of patients with in-hospital assessment of left ventricular function. When compared with patients with systolic dysfunction, patients with PSF were more likely to be older, women, and hypertensive and less likely to have had a prior myocardial infarction or be receiving an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker. In-hospital mortality was lower in patients with PSF compared with patients with systolic dysfunction (2.8% vs. 3.9%; adjusted odds ratio [OR]: 0.86; p = 0.005), but duration of intensive care unit stay and total hospital length of stay were similar. Serum creatinine >2 mg/dl was associated with increased in-hospital mortality in both systolic function groups (PSF: 4.8%; systolic dysfunction: 8.4%; p < 0.0001), and the most powerful predictors of in-hospital mortality in both groups were blood urea nitrogen >37 mg/dl (OR: 2.53; 95% confidence interval [CI]: 2.22 to 2.87) and systolic blood pressure < or =125 mm Hg (OR: 2.58; 95% CI: 2.33 to 2.86).Conclusions Heart failure with PSF is common and is characterized by a unique patient profile. Event rates are worrisome and reflect a need for more effective management strategies.

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Authors
Yancy, C. W., Lopatin, M., Stevenson, L. W., De Marco, T., & Fonarow, G. C.
Affiliations
  • The University of Texas Southwestern Medical Center (US)
  • Brigham and Women's Hospital (US)
  • University of California, Los Angeles (US)
Corresponding author
Yancy, Clyde W.
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2006-01
Volume
47
Issue
1
Pages
76-84
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2005.09.022
OpenAlex
W1511208491
Cited by
927
References
38
Citations by year
2026: 10 · 2025: 23 · 2024: 16 · 2023: 26 · 2022: 32 · 2021: 37 · 2020: 51 · 2019: 52 · 2018: 39 · 2017: 74 · 2016: 62 · 2015: 57 · 2014: 60 · 2013: 56 · 2012: 62
FWCI
23.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
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 › Takotsubo Cardiomyopathy and Associated Phenomena
Keywords
acute decompensated heart failure, in-hospital mortality, risk factors, blood urea nitrogen, serum creatinine, renal failure, systolic blood pressure, ACE inhibitors, angiotensin receptor blockers, ADHERE registry, length of hospital stay, ICU length of stay, left ventricular function
MeSH terms
Aged, Critical Care, Female, Heart Failure, Hospitalization, Humans, Length of Stay, Male, Stroke Volume, Systole, Ventricular Function, Left, Hospital Mortality

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