(B-247) Understanding the natural history of heart failure by ejection fraction: a systematic review of common comorbidities, readmission rates, and mortality rates

Background: Heart failure (HF) is commonly classified into distinct phenotypes by ejection fraction: HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF). However, the understanding of common comorbidities, readmission rates, and mortality rates by HF phenotype remains limited.

Objectives: The objective of this study was to perform a systematic review to contextualize the common comorbidities, readmission rates, and mortality rates by HF phenotype to better understand the natural history of the disease.

Methods: We conducted a search of electronic databases (Embase, Medline, PubMed, and Cochrane Library) through June 2023 and manually searched for citations. Inclusion criteria were population-based observational studies that reported any outcomes (comorbidities, readmission rates, and mortality rates) by HF phenotype in Western countries published between 2018-2023. Studies with data prior to 2010 were excluded. Two independent researchers screened studies and extracted data on study and patient characteristics, common comorbidities, readmission rates, and mortality rates by HF phenotype.

Results: This systematic literature review included 6 studies, 3 in the US, 1 in Spain, 1 in Sweden, and 1 in multiple European countries. These studies included a total of 5 296 417 individuals with HFrEF and 7 957 960 individuals with HFpEF. Fewer females (range HFrEF: 25.5-45.6% vs. HFpEF: 46.0-64.6%) as well as higher B-type natriuretic peptide (BNP, 942 vs. 480 pg/mL) and N-terminal proBNP (NT-proBNP, range 3054-3804 vs. 1559-2391 ng/L) levels were consistently observed in HFrEF than in HFpEF. For cardiovascular (CVD)-related comorbidities, HFpEF had a higher prevalence of hypertension and atrial fibrillation, while HFrEF had a higher prevalence of coronary artery disease and myocardial infarction. Data for peripheral vascular/arterial disease were mixed. Regarding other comorbidities, HFpEF was more likely to have a higher prevalence of hyperlipidemia and obesity, while data for diabetes, chronic kidney disease, and cancer were inconsistent. In addition, although data on readmission rates were inconclusive, HFrEF showed higher all-cause mortality (range HFrEF: 5.2-28.9% vs. HFpEF: 4.0-26.4%) and CVD-related mortality (range 11.8-15.6% vs. 4.4-11.3%) than HFpEF.

Conclusions: HFpEF was more likely to have hypertension, atrial fibrillation, stroke, hyperlipidemia, obesity, and chronic obstructive pulmonary disease, while HFrEF was more likely to have coronary artery disease and myocardial infarction. HFrEF also had a higher mortality rate than HFpEF.