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Characteristics and in-hospital outcomes of hospitalisations with heart failure with reduced or preserved ejection fraction undergoing percutaneous coronary intervention

Abstract

Background

Studies comparing characteristics and in-hospital outcomes for heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) for hospitalisations undergoing percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI) remain limited.

Aim

This sought to investigate characteristics and in-hospital outcomes for HFpEF and HFpEF hospitalisations undergoing STEMI-PCI.

Methods

The National inpatient sample database from years 2012 to 2014 was queried and appropriate International Classification of Disease, Ninth Revision, Clinical Modification codes were utilised to identify study cohorts. A total of 400,590 hospitalisations underwent STEMI-PCI, of which, 31,180 presented with acute heart failure (89.3% with acute HFrEF and 10.7% with acute HFpEF). The HFpEF cohort was older (65.6 vs. 69.9 years), consisted of more females (35% vs. 48.7%), and presented with significantly higher comorbidities as demonstrated by higher Charlson’s Comorbidity Index ≥ 3 (59.6 vs. 68%) (P < 0.001 for all). However, lower in-hospital mortality (9.2% vs. 8.0%, P = 0.04) was observed with HFpEF hospitalisations, which accompanied by lower mechanical circulatory support (MCS) device (20.3 vs. 12.3%, P < 0.001) use after propensity score matching. These translated to lower median hospitalisation cost ($28,116 vs. $27,823, P < 0.001) with HFpEF without significant change in median length of hospitalisation stay (6 vs. 6 days, P = 0.08).

Conclusions

This study highlights the distinct risk profile for hospitalisations with HFpEF undergoing STEMI-PCI. HFpEF hospitalisations are associated with the lesser need for MCS, lower in-hospital mortality, and ultimately lower hospitalisation cost compared to HFrEF.

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Correspondence to Rajkumar Doshi.

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Doshi, R., Patel, K., Gupta, N. et al. Characteristics and in-hospital outcomes of hospitalisations with heart failure with reduced or preserved ejection fraction undergoing percutaneous coronary intervention. Ir J Med Sci 188, 791–799 (2019). https://doi.org/10.1007/s11845-018-1910-2

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  • DOI: https://doi.org/10.1007/s11845-018-1910-2

Keywords

  • Heart failure with preserved ejection fraction
  • Heart failure with reduced ejection fraction
  • In-hospital outcomes
  • Percutaneous coronary intervention
  • ST-segment elevated myocardial infarction