Koh AS, et al. - This study entailed a comparison between heart failure with mid-range ejection fraction [HFmrEF, ejection fraction (EF) 40–49%] and heart failure with reduced EF (HFrEF, EF <40%) and preserved EF (HFpEF, EF ≥50%) in terms of clinical features and outcomes. As per findings, HFmrEF was characterized as an intermediate phenotype. In HFmrEF and HFrEF vs. HFpEF, coronary artery disease (CAD) was more commonly detected. However, in HFmrEF and HFrEF, crude all-cause mortality was lower. Additionally, the reported adjusted all-cause mortality was lower in HFmrEF and HFpEF, and CAD portended a higher adjusted risk of death in HFmrEF and HFrEF.

Methods

• Researchers used multivariable logistic regressions to examine the link between baseline characteristics and EF group, and multivariable Cox regressions to assess the association between EF group and all-cause mortality, in the Swedish Heart Failure Registry.

Results

• Among 42 061 patients, HFrEF, HFmrEF and HFpEF was reported in 56%, 21%, and 23%, respectively.
• Data reported that characteristics were continuous for age (72 ± 12 vs. 74 ± 12 vs. 77 ± 11 years), proportion of women (29% vs. 39% vs. 55%), and 13 other characteristics.
• Researchers observed that in HFrEF (54%) and HFmrEF (53%) vs. HFpEF (42%), coronary artery disease (CAD) was distinctly more common; adjusted odds ratio for CAD in HFmrEF vs. HFpEF was 1.52 [95% confidence interval (CI) 1.41–1.63].
• Findings demonstrated that for six additional characteristics HFmrEF resembled HFrEF, for seven characteristics HFmrEF resembled HFpEF, and for 10 characteristics there was no pattern.
• The adjusted hazard ratio (HR) for mortality in HFrEF vs. HFpEF was 1.35 (95% CI 1.14–1.60), 1.26 (95% CI 1.17–1.35), and 1.20 (95% CI 1.14–1.26) at 30 days, 1 year, and 3 years, respectively.
• In contrast, researchers found that HFmrEF and HFpEF had a similar prognosis (HR 1.06, 95% CI 0.86–1.30 at 30 days; HR 1.08, 95% CI 1.00–1.18 at 1 year; and HR 1.06, 95% CI 1.00–1.12 at 3 years).
• Additionally, in HFmrEF versus HFpEF, three-year mortality was found to be higher in the presence of CAD (HR 1.11, 95% CI 1.02–1.21), but not in the absence of CAD (HR 1.02, 95% CI 0.94–1.12; P for interaction <0.001).