Characteristics and outcome for heart failure patients with mid-range ejection fraction

The aim of this study was to compare precipitants, presenting symptoms and outcomes of patients with heart failure and mid-range ejection fraction (HFmrEF), heart failure and preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) in an Australian cohort.

We divided 5236 patients in the Management of Cardiac Failure program in Northern Sydney Australia, into HFmrEF (n = 780, 14.9%), HFpEF (n = 1956, 37.4%) and HFrEF (n = 2500, 47.8%), using a cutoff left ventricular ejection fraction of 40-49, at least 50 and less than 40%, respectively.

For most characteristics, the HFmrEF patients were intermediate. Hypertension among the HFrEF, HFmrEF and HFpEF groups was present in 50.6, 61.7 and 68.9%, respectively; age more than 85 years was present in 35.1, 37.6 and 42.2%; atrial fibrillation in 35.3, 44.2 and 49.9%; and elevated serum creatinine (>100 μmol/l) in 59.2, 55.6 and 51.0%. For ischemic heart disease and ischemia as a precipitant of admission, HFmrEF patients were similar to the HFrEF group, and more common than in HFpEF. Mortality rates were not significantly different between the three groups. Readmission rates were highest for HFpEF (40.2%), followed by HFmrEF (42.4%) and HFrEF (45.4%), largely due to differences in nonheart failure readmission.

Clinically, HFmrEF represents an intermediate phenotype, with the exception of resembling HFrEF with a higher incidence of ischemic heart disease.