Clinical Characteristics of Admitted Heart Failure Patients with Preserved Mid-Range and Reduced Ejection Fraction

Abstract

Background: Heart failure (HF) presents a serious burden in India, with estimated prevalence ranging from 1.3 to 4.6 per million populations. Heart failure risk factors are diverse and probably vary by geographical region. It is essential for reducing mortality, preventing rehospitalization, and enhancing quality of life to optimize treatment early on with guideline-directed medical therapies (GDMTs) in patients with HF. The aim of this research is to determine the factors that lead to hospitalization and to identify risk factors associated with each subtype of HF. The research evaluates the clinical traits of hospitalized heart failure (HF) patients categorized into those with preserved ejection fraction (HFpEF; EF ≥50%), mid-range ejection fraction (HFmrEF; EF 41%–49%), and reduced ejection fraction (HFrEF; EF <⁠40%).

Materials and Methods: Cross-sectional prospective study conducted in a Tertiary Care Centre at Puducherry (18 months), enrolling 240 heart failure patients via convenient sampling. Data collected included demographics, medical history, physical exam, chest X-ray, ECG, CBC, renal function, blood sugar, and lipid profile. Comorbidities assessed were hypertension, diabetes, CAD, CVA, chronic renal failure (creatinine ≥2.0 mg/dL or dialysis), anemia (Hb <13 g/dL in men, <12 g/dL in women), and atrial fibrillation. All patients underwent 2-D echocardiography with LVEF measured by Simpson’s method. Heart failure was classified as HFrEF (<40%), HFmrEF (41–49%), or heart rate with preserved ejection fraction (HFpEF) (≥50%). Risk factors, hospitalization triggers, and in-hospital outcomes were documented.

Results: In the present study, heart failure patients classified by ejection fraction found HFrEF most common (61.25%), followed by HFmrEF (18.75%) and HFpEF (20%). Mean age was 61.6 years with predominance of males particularly in HFmrEF, whereas HFpEF cases had more females. Acute de novo cases were more frequent. Diabetes (78.8%), hypertension (72.9%), and CAD (67.9%) were major comorbidities, with CAD most prevalent in HFrEF and HFmrEF. Breathlessness (78.3%) and edema (58.8%) were the leading symptoms. Anemia affected 78.3%, mostly in HFrEF. The ECG revealed a sinus rhythm (63.3%), atrial fibrillation (AF) at 21.7%, and left ventricular hypertrophy (LVH) at 25.8%. Cardiomegaly (49.6%) and signs of pulmonary congestion were shown on chest X-rays. The average EF was 38%, and RWMA and valvular issues were prevalent. Drug and dietary non-compliance were major causes. GDMT adherence was moderate, withACEi/ARB/ARNI used in 64.2%, beta-blockers in 56%, and SGLT2 inhibitors highest in HFrEF.

Conclusion: This heart failure registry provides clinical characterization of admitted heart failure patients classified by heart failure subtypes. There were significant differences among each heart failure subgroups when compared to other Indian cohorts. Our study gives an opportunity to improve the care for heart failure patients and increase awareness of modifiable risk factors and precipitating factors for hospital admission.

KEYWORDS:

Heart failure patients, Acute de novo, HF with preserved ejection fraction, mid-range ejection fraction and reduced EF.