Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Profiles of comorbidity as an important risk modifier in patients discharged after an episode of acutely decompensated non-systolic heart failure

J. Albert1, N. Seer1, N. Scholz1, F. Sahiti1, V. Cejka1, U. Stefenelli1, C. Morbach1, G. Ertl2, C. E. Angermann1, S. Störk1

1Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Würzburg; 2Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg;

Introduction & Aim: Prior studies used data from randomized trials to derive prognostically important phenotyping clusters from patients with chronic heart failure and a preserved ejection fraction (HFpEF). We investigated the prognostic utility of such clusters in real-world patients hospitalized for acute heart failure (AHF). Method & Results: Out of 1000 patients hospitalized for AHF and enrolled in an ongoing registry, we assigned 561 participants with a left ventricular ejection fraction (LVEF) ≥40% (mean age 76±10 years, 56% men) to six clusters previously derived from the I-PRESERVE and CHARM-Preserved trials (Kao D et al, EJHF 2015). Cluster derivation was based on information of 11 key variables (age, gender, body mass index, coronary artery disease, diabetes mellitus, hyperlipidemia, valvular heart disease, alcohol use, glomerular filtration rate, and hematocrit). Primary outcome was the composite endpoint of all-cause death and cardiovascular rehospitalization 6 months after AHF. Respective allocation led to the subgroup distribution displayed in the Table. Patients categorized into one of the less prevalent subgroups (A=4%, B=2%, D=9%) were younger, had lower rates of atrial fibrillation, coronary artery disease, hyperlipidemia, renal dysfunction and valvular heart disease. By contrast, subgroups with higher prevalence (C=23%, E=17%, F=45%) exhibited the highest burden of comorbidities and risk factors. E.g., for group C: diabetes mellitus (90%), hyperlipidemia (82%) and coronary artery disease (62%); or group F: atrial fibrillation (66%), renal dysfunction (83%) and valvular heart disease (45%). Furthermore, subgroups differed regarding E/e’ ratio (i.e., surrogate for elevated left ventricular filling pressure and impaired relaxation) and NT-proBNP levels (overall p<0.001 for both), with highest measurements in groups C and F (Table). Importantly, LVEF, global longitudinal peak systolic strain, and systolic blood pressure were similar across groups. During follow-up, the primary endpoint occurred in 113 patients, with significant subgroup differences (p=0.026) and highest eventrates in subgroup F (Table). Conclusion: Classification of AHF patients with LVEF ≥40% by pre-defined clinical parameters reproduced six subgroups with distinct patterns regarding metabolic profile, cardiac function and 6-month outcome. These findings illustrate the importance of comorbidities as an important risk modifier for patients with heart failure and a mildly reduced or preserved LVEF after an episode of AHF.

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