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Epidemiology and long-term outcome in outpatients with chronic heart failure in north-western europe

Session Poster Session 1

Speaker Hanna Froehlich

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : H Froehlich (Heidelberg,DE), N Rosenfeld (Heidelberg,DE), T Taeger (Heidelberg,DE), K Goode (Cottingham,GB), S Kazmi (Cottingham,GB), T Hole (Trondheim,NO), HA Katus (Heidelberg,DE), D Atar (Oslo,NO), JGF Cleland (London,GB), S Agewall (Oslo,NO), AL Clark (Cottingham,GB), L Frankenstein (Heidelberg,DE), M Grundtvig (Lillehammer,NO)

H Froehlich1 , N Rosenfeld1 , T Taeger1 , K Goode2 , S Kazmi2 , T Hole3 , HA Katus1 , D Atar4 , JGF Cleland5 , S Agewall4 , AL Clark2 , L Frankenstein1 , M Grundtvig6 , 1University Hospital of Heidelberg - Heidelberg - Germany , 2Castle Hill Hospital - Cottingham - United Kingdom of Great Britain & Northern Ireland , 3Norwegian University of Science and Technology - Trondheim - Norway , 4Oslo University Hospital - Oslo - Norway , 5Imperial College London - London - United Kingdom of Great Britain & Northern Ireland , 6Innlandet Hospital - Lillehammer - Norway ,


Objective: To describe the epidemiology, long-term outcomes and temporal trends in mortality in ambulatory patients with chronic heart failure (HF) with reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF) from three European countries.

Methods: We identified 10,312 patients from three European HF registries. Patients were classified according to baseline left ventricular ejection fraction (LVEF) and time of enrolment (period 1: 1995-2005 vs. period 2: 2006-2015). Predictors of mortality were analysed by use of univariable and multivariable Cox regression analyses.

Results: Among 10,312 patients with stable HF, 7,080 (68.7%), 2,086 (20.2%), and 1,146 (11.1%) were classified as having HFrEF, HFmrEF, or HFpEF, respectively. A total of 4,617 (44.8%) patients was included in period 1, and 5,695 (55.2%) patients were included in period 2. Baseline characteristics significantly differed with respect to type of HF and time of enrolment. During a median follow-up of 66 (33-105) months, 5,297 patients (51.4%) died. In multivariable analyses, survival was independent of LVEF category (p>0.05), while mortality was lower in period 2 as compared to period 1 (HR 0.81, 95% CI 0.72-0.91, p<0.001). Significant predictors of all-cause mortality regardless of HF category were increasing age, NYHA functional class, NT-proBNP, and use of loop diuretics.

Conclusion: Ambulatory HF patients stratified by LVEF represent different phenotypes. However, after adjusting for a wide range of covariates, long-term survival is independent of LVEF category. Outcome significantly improved during the last two decades irrespective from type of HF.

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