Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction

Paloma Gastelurrutia, PhD; Josep Lupón, MD, PhD; Pedro Moliner, MD; Xiaobo Yang, MB; German Cediel, MD, PhD; Marta de Antonio, MD, PhD; Mar Domingo, MD, PhD; Salvador Altimir, MD; Beatriz González, CN; Margarita Rodríguez, CN; Carmen Rivas, CN; Violeta Díaz, CN; Erik Fung, MB, ChB, PhD; Elisabet Zamora, MD, PhD; Javier Santesmases, MD; Julio Núñez, MD, PhD; Jean Woo, MD; Antoni Bayes-Genis, MD, PhD, FESC

Mayo Clinic Proceedings: Innovations, Quality & Outcomes (Jun 2018)

Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction

Paloma Gastelurrutia, PhD,
Josep Lupón, MD, PhD,
Pedro Moliner, MD,
Xiaobo Yang, MB,
German Cediel, MD, PhD,
Marta de Antonio, MD, PhD,
Mar Domingo, MD, PhD,
Salvador Altimir, MD,
Beatriz González, CN,
Margarita Rodríguez, CN,
Carmen Rivas, CN,
Violeta Díaz, CN,
Erik Fung, MB, ChB, PhD,
Elisabet Zamora, MD, PhD,
Javier Santesmases, MD,
Julio Núñez, MD, PhD,
Jean Woo, MD,
Antoni Bayes-Genis, MD, PhD, FESC

Affiliations

Paloma Gastelurrutia, PhD: ICREC Research Program, Germans Trias i Pujol Research Institute in Health Sciences, Badalona, Spain; Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
Josep Lupón, MD, PhD: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, UAB, Barcelona, Spain; CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
Pedro Moliner, MD: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
Xiaobo Yang, MB: The Chinese University of Hong Kong, Hong Kong SAR, China
German Cediel, MD, PhD: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
Marta de Antonio, MD, PhD: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain; CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
Mar Domingo, MD, PhD: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
Salvador Altimir, MD: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
Beatriz González, CN: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
Margarita Rodríguez, CN: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
Carmen Rivas, CN: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
Violeta Díaz, CN: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
Erik Fung, MB, ChB, PhD: The Chinese University of Hong Kong, Hong Kong SAR, China
Elisabet Zamora, MD, PhD: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, UAB, Barcelona, Spain; CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
Javier Santesmases, MD: Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
Julio Núñez, MD, PhD: CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain; Clinic University Hospital, INCLIVA, Department of Medicine, University of València, València, Spain
Jean Woo, MD: The Chinese University of Hong Kong, Hong Kong SAR, China
Antoni Bayes-Genis, MD, PhD, FESC: ICREC Research Program, Germans Trias i Pujol Research Institute in Health Sciences, Badalona, Spain; Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, UAB, Barcelona, Spain; CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain; Correspondence: Address to Antoni Bayes-Genis, MD, PhD, Heart Institute, Hospital Universitari Germans Trias i Pujol, Department of Medicine, UAB, Carretera del Canyet s/n 08916, Badalona, Spain.

Journal volume & issue: Vol. 2, no. 2
pp. 176 – 185

Abstract

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Objective: To assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area. Patients and Methods: Consecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older Americans Resources and Services scale, Pfeiffer Test, and abbreviated-Geriatric Depression Scale). The QOL was assessed with the Minnesota Living with Heart Failure Questionnaire. A comorbidity score (0-7) was constructed. All-cause death, HF-related hospitalization, and the composite end point of both were assessed. Results: Comorbidities and QOL scores were similar in HFmrEF (2.41±1.5 and 30.1±18.3, respectively) and HFrEF (2.30±1.4 and 30.8±18.5, respectively) and were higher in HFpEF (3.02±1.5, P<.001, and 36.5±20.7, P=.003, respectively). No statistically significant differences in fragility between HFmrEF (48.6%) and HFrEF (41.9%) (P=.09) nor HFpEF (54.3%) (P=.29) were found. In univariate analysis, the association of comorbidities, QOL, and fragility with the 3 end points was higher for HFmrEF than for HFrEF and HFpEF. In multivariate analysis, comorbidities were independently associated with the 3 end points (P≤.001), and fragility was independently associated with all-cause death and the composite end point (P<.001) in HFmrEF. Conclusion: Comorbidities and fragility are independent predictors of outcomes in ambulatory patients with HFmrHF and should be considered in the routine clinical assessment of HFmrEF.

Published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes

ISSN: 2542-4548 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General)
Website: https://www.journals.elsevier.com/mayo-clinic-proceedings-innovations-quality-and-outcomes/

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