High 5-Year Mortality Rates in Heart Failure, Regardless of Ejection Fraction

Background: Left ventricular ejection fraction (EF) is commonly used to assess patients with heart failure (HF). Previous research found conflicting results regarding EF`s association with mortality. We stratified patients hospitalized with a primary diagnosis of HF at Sheba Medical Center (Ramat Gan, Israel) from 2008-2017 based on EF (preserved >50%, borderline 40-49%, and reduced <40%) and examined their characteristics and outcomes.

Methods: Patient data including comorbidities, lab results and echocardiographic reports were analyzed. Analysis of variance, Pearson`s Chi-squared, and the log-rank test were used where appropriate.

Results: EF was measured in 3,838 patients hospitalized with HF - 2,116 had preserved EF, 237 had borderline EF and 1,485 had reduced EF. Patients with preserved EF were more likely to be female (59%, 38% and 31%, preserved, borderline, and reduced EF, p<0.001), and had lower rates of left ventricular dilatation (4%, 15%, and 40%, respectively, p<0.001). Patients with a reduced EF were more likely to be admitted to the cardiac ICU (5%, 8%, and 23%, normal, borderline, and reduced EF, p<0.001). Overall mortality varied according to EF (log-rank test, p=0.036), with 5 year mortality estimated between 58%-61% (figure).

Conclusion: Although mortality rates were statistically different between patients with HF and different EF categories, they were clinically similar. HF diagnosis carries a high 5 year mortality rate, independent of EF at the time of diagnosis.

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