Comorbidities, risk factors and outcomes in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care- and hospital care-based outpatient clinics

Figures & data

Figure 1. Schematic patient selection.

Table 1 Characteristics in patients with an EF equal to or above 40%, overall and matched cohorts.

	Overall cohort		Matched cohort
	Primary care, n = 1802	Hospital care, n = 7852	Primary care, n =1499	Hospital care, n = 1499
Variabels	Mean ± SD or %	Mean ± SD or %	Mean ± SD or %	Mean ± SD or %
Dead during follow up, %	31.5	27.8**	29.7	34.6**
Age, years	77.5 ± 8.9	70.3 ± 12.4***	77.4 ± 8.7	77.1 ± 8.7
Follow up time, mean days	1151.2 ± 752.5	1286.8 ± 925.5***	1189.9 ± 761.5	1212.0 ± 880.6
Sex
Male	53.3	63.7***	53.8	53.8
Female	46.7	36.3***	46.2	46.2
Smoking		**
Current	7.8	11.0	8.0	8.1
Former	43.0	42.4	42.5	38.0
Never	49.2	46.6	49.5	53.9
Duration heart failure, months		***		***
>6 months	73.0	50.2	71.6	48.7
<6 months	27.0	49.8	28.4	51.3
Functional class NYHA		**		***
NYHA-class I	15.4	17.8	16.1	12.3
NYHA-class II	57.3	51.3	58.0	52.3
NYHA-class III	26.0	29.7	24.5	34.2
NYHA-class IV	1.4	1.0	1.4	1.3
QRS duration, mean ms	103,3 ± 26.3	104,8 ± 25.1*	103,8 ± 26.4	105,4 ± 26.9
ECG-rhythm		***		**
Sinus	53.2	58.2	55.0	53.4
Atrial fibrillation/flutter	40.5	33.1	38.9	37.7
Systolic blood pressure, mean mmHg	134,5 ± 20.3	129,5 ± 21.0***	139,0 ± 17.5	137,4 ± 17.3*
Diastolic blood pressure, mean mmHg	75.1 ± 11.1	73.8 ± 11.7***	76.6 ± 10.7	74.8 ± 10.7***
Co-morbidity
IHD	57.8	32.7***	40.2	42.5***
IHD with coronar angiography	14.6	25.1	14.5	20.6
IHD without coronar angiography	27.6	17.6	27.7	21.9
Hypertension	67.0	48.9***	70.2	56.2***
Atrial fibrillation/flutter	53.0	47.2***	51.6	51.5
Valvular disease	23.8	22.6	23.4	26.1
COPD	24.5	15.2***	24.1	14.5***
Diabetes	21.1	20.1	22.3	20.4*
Hemoglobin, mean g/L	134,0 ± 15.5	134,8 ± 16.4*	134,3 ± 15.4	132,6 ± 15.6**
Creatinine, micromol/L	99.4 ± 35.1	100,3 ± 46.7	99.0 ± 35.0	100,5 ± 42.0
eGFR, mean mL/min	62.3 ± 21.6	67.3 ± 38.3***	62.6 ± 21.5	62.1 ± 21.0
eGFR classes		***
<30	4.8	4.4	4.7	4.7
30–59	43.3	37.1	43.2	43.2
60–89	41.8	44.2	42.0	42.0
>90	10.1	14.3	10.1	10.1
Medical treatment
ACEi	56.1	65.2***	56.2	62.6***
ARB	28.7	27.1	29.3	26.8
ACEi or ARB	83.2	90.2**	83.7	87.6*
BB	74.1	86.9***	74.2	85.7***
ACEi or ARB + BB	63.7	78.6***	63.8	75.2***
MRA	20.6	24.9***	19.5	21.0
Diuretics	32.7	34.2***	33.6	35.0**
Digoxin	14.9	13.0*	14.8	13.9
Statins	45.2	48.8**	46.3	46.2
Nitrates	12.6	11.3	12.3	14.9*
ACEi or ARB + BB + MRA	12.8	19.3***	12.4	14.8*
Oral anticoagulants	39.6	42.0	38.7	42.8*
Aspirin or other trombocyte inhibitors	44.6	44.4	45.2	47.4
Oral antidiabetics	5.8	6.0	5.6	6.5
Insulin	7.1	5.8*	8.0	5.4**

Continuous data are presented as mean + SD and statistically assessed by t-test and categorical data as proportions (%) assessed by chi₂-test.

ACEi: ACE-inhibitors; ARB: Angiotensin receptor blockers; BB: Beta blockers; CABG: Coronary artery bypass grafting; COPD: Chronic obstructive pulmonary disease; CRT: Cardiac resynchronization therapy; DCM: Dilated cardiomyopathy; ICD: Implantable cardioverter defibrillator; IHD: Ischemic heart disease; MRA: Mineral corticoid receptor antagonist; NYHA: New York Heart Association; PCI: Percutaneous coronary intervention.

* p-value <0.05; **p-value <0.01; BB: Beta blockers; ***p-value <0.0001.

Figure 2. Survival curves (Kaplan-Meier method) illustrating all-cause mortality in primary care based and hospital care based outpatients, the overall cohorts separately.

Table 2. All cause mortality rates in out-patients with an EF of more than or equal to 40%.

Patients with EF ≥40% PC and HC overall cohorts
	1 year mortality rate		3 years mortality rate	5 years mortality rate
Primary care N = 1802	7.8		22.8	28.9
Hospital care N = 7852	7.0		17.0	23.0
Patients with EF ≥40–49% PC and HC overall cohorts
	1 year mortality rate		3 years mortality rate	5 years mortality rate
Primary care N = 753	8.5		22.4	28.3
Hospital care N = 4881	6.8		16.0	21.7
Patients with EF ≥50% PC and HC overall cohorts
	1 year mortality rate		3 years mortality rate	5 years mortality rate
Primary care N = 1049	7.3		23.0	29.3
Hospital care N = 2971	7.5		18.7	25.3
Patients with EF ≥40% PC and HC matched cohorts
	1 year mortality rate		3 years mortality rate	5 years mortality rate
Primary care N = 1499	7.0		20.8	27.0
Hospital care N = 1499	7.7		20.3	27.9
Patients with EF ≥40% with any comorbidity
	1 year	3 years	5 years	All follow-up
Primary care N = 1671	8.0	23.0	29.1	31.5
Hospital care N = 6750	7.4	17.8	24.0	28.9
Patients with EF ≥40% with no comorbidity
	1 year	3 years	5 years	All follow-up
Primary care N = 50	8.0	20.0	24.0	30.0
Hospital care N = 608	3.3	7.7	10.0	12.8

Figure 3. Hazard ratios with 95% CI indicating potential impact of co-morbidities on all-cause mortality in PC and HC overall cohorts.