Sobrevida de pacientes com insuficiência cardíaca e fração de ejeção do ventrículo esquerdo entre 40-59% - estudo de coorte com seguimento de 10 anos

Abstract

Background: Heart failure (HF) with mid-range ejection fraction (HFmrEF), has been included in different guidelines and has contributed to a better characterization of patients with HF. Currently, the need to expand the mid-range group to an EF between 40-59% has been discussed. Objective: To evaluate and compare the survival rate in patients with HF and EF between 40-59%, comparing it with patients with HF and reduced EF (HFrEF), and patients with HF and EF ≥ 60%, and to evaluate the impact on total mortality and cardiovascular causes. Methods: Retrospective cohort study that included 400 patients with HF followed-up for a 10-year period. The sample was divided into three groups according to EF: reduced (<40%), EF 40-59% and EF ≥60%. Kaplan-Meier curve was analyzed according to the EF, and a logistic regression analysis was performed. Statistical significance was established at p <0.05. Results: Of a total of 423 patients admitted for decompensated HF, 400 were followed for a period of 10 years. The average age was 69 ± 14 years, the majority were female (53.3%). Most of the patients in the sample had a LVEF between 40-59% (36.2%); the etiology ischemic heart disease was more prevalent in patients with LVEF <40% (42.0%) and hypertensive in groups with LVEF between 40%-59% (46.2%) and LVEF ≥ 60% (47.5%). In relation to total mortality, EF between 40-59% compared to EF <40%: HR 0.89 (IC 95% 0.68-1.17); EF ≥ 60% compared to EF < 40%: HR 0.78 (IC 95% 0.59-1.04) P=0,094. Regarding cardiovascular mortality, EF between 40-59% compared with EF <40%: HR 0.86 (IC 95% 0.61-1.22); EF ≥ 60% compared to EF <40%: HR 0.64 (IC 95% 0.44-0.94) P=0,023. Conclusions: There was no difference in the survival rate between the different EF groups evaluated. Patients with HF and EF between 40-59% had similar total mortality compared to patients with reduced EF and EF ≥ 60%; mortality from cardiovascular causes was significantly lower in the EF ≥ 60% group, but there was no difference between patients with reduced EF and EF between 40-59%.