DOI: 10.1161/circ.148.suppl_1.13434 ISSN: 0009-7322

Abstract 13434: Prognostic Impact of Functional Limitations in Acute Decompensated Heart Failure Patients With Reduced & Preserved Left Ventricular Ejection Fraction

Takeshi Fujita, Takahisa Yamada, Tetsuya Watanabe, Takashi Morita, Masato Kawasaki, Atsushi Kikuchi, Takumi Kondo, Tsutomu Kawai, Yuji Nishimoto, Yongchol Chang, Masanao Taniichi, Takuya Oshita, Yuki Kokubu, Yuto Fukuda, Makoto Kinugawa, KENTARO SHIMIZU, Katsuyoshi Sakai
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: Although functional limitations (FL) could predict clinical status in patients with heart failure (HF), these clinical significances have not been fully elucidated.

Hypothesis: Severe FL would be associated with poor prognosis both in patients with HFrEF and HFpEF.

Aims: The purpose of this study was to examine the prognostic significance of FL in patients with acute decompensated heart failure (ADHF), relating to left ventricular ejection fraction (LVEF).

Methods: We studied 340 patients admitted for ADHF in our prospective cohort study (Osaka Prefectural Acute heart failure Registry: OPAR study)(HFrEF[LVEF≤50%]:n=175 and HFpEF[LVEF>50%]:n=165). Clinical data, echocardiography and venous blood sampling were performed just before discharge. FL were evaluated using the Performance Measure for Activities of Daily Living-8 (PMADL-8 ranges 8-32, and higher scores indicate worse FL). The endpoint was the composite of worsening heart failure rehospitalization and cardiac death.

Results: During a follow up period of 3.0±1.9 years, 123 patients (64 patients in HFrEF and 59 patients in HFpEF) reached the primary endpoint. PMADL-8 was significantly smaller in patients with HFrEF than HFpEF (18.9±7.1 vs 21.0±6.1, p=0.004). On multivariate Cox analysis, PMADL-8 score was an independent risk factor for the primary endpoint both in HFrEF and HFpEF after adjustment for major confounders (age, sex, systolic blood pressure, and plasma brain natriuretic peptide level). Patients with high PMADL-8 scores had a higher risk of the primary endpoint than those with low PMADL-8 scores both in HFrEF (≥16 defined by ROC analysis, AUC 0.590[0.503-0.676]; adjusted hazard ratio: 2.20 [95%CI 1.08-4.48], 43% vs 25%, p=0.03) and HFpEF (≥25 defined by ROC analysis, AUC 0.617 [0.528-0.707]; adjusted hazard ratio: 1.95 [95%CI 1.04-3.66], 50% vs 29%, p=0.04).

Conclusion: FL evaluated based on PMADL-8 was associated with poor prognosis in ADHF patients with both HFrEF and HFpEF.

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