Prospective Analysis of Patients with Heart Failure with Mildly Reduced Ejection Fraction: A Tertiary Care Observational Study

Abstract

Background: Heart failure (HF) is growing in epidemic proportion due to a spectrum of cardiovascular diseases leading to myocardial dysfunction. HF with mildly reduced ejection fraction (HFmrEF) is a unique phenotype of HF with differences in clinical features as compared to other phenotypes of HF. Materials and Methods: A single center tertiary care hospital-based prospective observational study comprising urban/rural based 157 patients aged 18 years. Heart failure of any etiology will be included after primarily excluding Sepsis as an inciting factor for worsening/initiation of HFmrEF. These patients will be followed up for a period of 6 months with their clinicopathological      correlates. Results: Study analysis revealed Male sex, overweight BMI subset, NYHA class at presentation, presence of CAD & CKD predicted both incident and worsening HFmrEF. Hospitalized patients with HFmrEF have more morbidity and mortality than ambulatory patients. HF with mildly reduced LVEF in their lower range (LVEF 41-45%) had a poor prognosis compared to those with upper ranges of HFmrEF (46-49%). There were patient and drug-related factors in initiating core heart failure medications as suggested by ESC HF guidelines Conclusion: Heart failure with mildly reduced ejection fraction is a clinical spectrum of heart failure characterized as a transitioning stage in the natural course of heart failure. There are significant differences in patient profiles demanding individualized protocol for addressing specific triggers and targets of HFmrEF. Phenotyping, treatment options, early achievement in LVEF recovery, and serial follow-up of LVEF with echocardiography of this small subset of HF will help in changing the trajectory of natural history of HFmrEF patients.