Clinical Outcomes and Haemodynamics: High Output Heart Failure Versus Heart Failure With Preserved Ejection Fraction

Area of Science:

• Cardiology
• Internal Medicine
• Clinical Research

Background:

• High-output heart failure (HOHF) is a poorly understood cardiac condition characterized by increased cardiac output (CO) and elevated filling pressures.
• HOHF is often mistaken for other forms of heart failure, necessitating clearer diagnostic and prognostic understanding.

Purpose of the Study:

• To compare mortality, morbidity, and hemodynamic profiles of patients with HOHF against those with heart failure with preserved ejection fraction (HFpEF).
• To investigate the clinical outcomes and characteristics of HOHF patients within a large veteran cohort.

Main Methods:

• Retrospective analysis of 13,422 US Veterans Affairs patients with invasive hemodynamic assessment (right heart catheterization) from 2007-2022.
• Patients were categorized into HOHF (CO ≥8 L/min and CI >4 L/min/m² ) and control (HFpEF) groups.
• Comparison of all-cause mortality, hospitalizations (overall and HF-specific), and a composite outcome of mortality/rehospitalization within one year.

Main Results:

• 450 patients were classified in the HOHF group, and 12,972 in the control group.
• No significant differences were observed in mortality or morbidity outcomes between the HOHF and HFpEF groups.
• Factors associated with mortality in the overall cohort included older age, obstructive lung disease, alcohol/tobacco abuse, atrial fibrillation, and liver disease.

Conclusions:

• Despite distinct pathophysiological and hemodynamic differences, HOHF does not appear to be associated with increased mortality or morbidity compared to HFpEF.
• The findings suggest that current management strategies for HFpEF may be applicable to HOHF patients, pending further investigation.
• Identifying specific risk factors for mortality in this population is crucial for targeted interventions.