Skip to main content

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

Irish Journal of Medical Science (1971 -) volume 188, pages 791–799 (2019)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, Gong Y, Liu PP (2006) Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med 355(3):260–269. https://doi.org/10.1056/NEJMoa051530

    Article  CAS  PubMed  Google Scholar 

  2. Shah KS, Xu H, Matsouaka RA, Bhatt DL, Heidenreich PA, Hernandez AF, Devore AD, Yancy CW, Fonarow GC (2017) Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. J Am Coll Cardiol 70:2476–2486. https://doi.org/10.1016/j.jacc.2017.08.074

    Article  PubMed  Google Scholar 

  3. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force M, Document R (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18(8):891–975. https://doi.org/10.1002/ejhf.592

    Article  PubMed  Google Scholar 

  4. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL, American College of Cardiology F, American Heart Association Task Force on Practice G (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62(16):e147–e239. https://doi.org/10.1016/j.jacc.2013.05.019

    Article  PubMed  Google Scholar 

  5. Oktay AA, Rich JD, Shah SJ (2013) The emerging epidemic of heart failure with preserved ejection fraction. Curr Heart Fail Rep 10(4):401–410. https://doi.org/10.1007/s11897-013-0155-7

    Article  PubMed  Google Scholar 

  6. Steinberg BA, Zhao X, Heidenreich PA, Peterson ED, Bhatt DL, Cannon CP, Hernandez AF, Fonarow GC, Get With the Guidelines Scientific Advisory C, Investigators (2012) Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation 126(1):65–75. https://doi.org/10.1161/CIRCULATIONAHA.111.080770

    Article  PubMed  Google Scholar 

  7. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355(3):251–259. https://doi.org/10.1056/NEJMoa052256

    Article  CAS  PubMed  Google Scholar 

  8. Cheng RK, Cox M, Neely ML, Heidenreich PA, Bhatt DL, Eapen ZJ, Hernandez AF, Butler J, Yancy CW, Fonarow GC (2014) Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population. Am Heart J 168(5):721–730. https://doi.org/10.1016/j.ahj.2014.07.008

    Article  PubMed  Google Scholar 

  9. Van Aelst LNL, Arrigo M, Placido R, Akiyama E, Girerd N, Zannad F, Manivet P, Rossignol P, Badoz M, Sadoune M, Launay JM, Gayat E, Lam CSP, Cohen-Solal A, Mebazaa A, Seronde MF (2017) Acutely decompensated heart failure with preserved and reduced ejection fraction present with comparable haemodynamic congestion. Eur J Heart Fail 20:738–747. https://doi.org/10.1002/ejhf.1050

    Article  CAS  PubMed  Google Scholar 

  10. Blecker S, Paul M, Taksler G, Ogedegbe G, Katz S (2013) Heart failure-associated hospitalizations in the United States. J Am Coll Cardiol 61(12):1259–1267. https://doi.org/10.1016/j.jacc.2012.12.038

    Article  PubMed  Google Scholar 

  11. Holper EM, Blair J, Selzer F, Detre KM, Jacobs AK, Williams DO, Vlachos H, Wilensky RL, Coady P, Faxon DP, Percutaneous Transluminal Coronary Angioplasty R, Dynamic Registry I (2006) The impact of ejection fraction on outcomes after percutaneous coronary intervention in patients with congestive heart failure: an analysis of the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry and Dynamic Registry. Am Heart J 151(1):69–75. https://doi.org/10.1016/j.ahj.2005.03.053

    Article  PubMed  Google Scholar 

  12. Mamas MA, Anderson SG, O'Kane PD, Keavney B, Nolan J, Oldroyd KG, Perera D, Redwood S, Zaman A, Ludman PF, de Belder MA, British Cardiovascular Intervention S, the National Institute for Cardiovascular Outcomes R (2014) Impact of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. Eur Heart J 35(43):3004–3012a. https://doi.org/10.1093/eurheartj/ehu303

    Article  CAS  PubMed  Google Scholar 

  13. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. NIS database documentation archive. Rockville, MD; June 2016.www.hcup-us.ahrq.gov/db/nation/nis/nisarchive.jsp. Accessed December 6, 2017

  14. Khera R, Angraal S, Couch T, Welsh JW, Nallamothu BK, Girotra S, Chan PS, Krumholz HM (2017) Adherence to methodological standards in research using the National Inpatient Sample. JAMA 318(20):2011–2018. https://doi.org/10.1001/jama.2017.17653

    Article  PubMed Central  PubMed  Google Scholar 

  15. Doshi R, Rao G, Shlofmitz E, Donnelly J, Meraj P (2017) Comparison of in-hospital outcomes after percutaneous revascularization for peripheral arterial disease in patients with a body mass index of >30 kg/m(2) versus </=30 kg/m(2) (from the National Inpatient Sample). Am J Cardiol 120(9):1648–1652. https://doi.org/10.1016/j.amjcard.2017.07.065

    Article  PubMed  Google Scholar 

  16. Patel N, Kalra R, Doshi R, Arora H, Bajaj NS, Arora G, Arora P (2018) Hospitalization rates, prevalence of cardiovascular manifestations, and outcomes associated with sarcoidosis in the United States. J Am Heart Assoc 7(2):e007844. https://doi.org/10.1161/JAHA.117.007844

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS (2010) Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 362(23):2155–2165. https://doi.org/10.1056/NEJMoa0908610

    Article  CAS  PubMed  Google Scholar 

  18. Epstein AJ, Polsky D, Yang F, Yang L, Groeneveld PW (2011) Coronary revascularization trends in the United States, 2001-2008. JAMA 305(17):1769–1776. https://doi.org/10.1001/jama.2011.551

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Goyal P, Almarzooq ZI, Horn EM, Karas MG, Sobol I, Swaminathan RV, Feldman DN, Minutello RM, Singh HS, Bergman GW, Wong SC, Kim LK (2016) Characteristics of hospitalizations for heart failure with preserved ejection fraction. Am J Med 129(6):635):e615–e626. https://doi.org/10.1016/j.amjmed.2016.02.007

    Article  Google Scholar 

  20. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619

    Article  CAS  PubMed  Google Scholar 

  21. Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28(25):3083–3107. https://doi.org/10.1002/sim.3697

    Article  PubMed Central  PubMed  Google Scholar 

  22. Taniguchi T, Shiomi H, Morimoto T, Watanabe H, Ono K, Shizuta S, Kato T, Saito N, Kaji S, Ando K, Kadota K, Furukawa Y, Nakagawa Y, Horie M, Kimura T (2017) Incidence and prognostic impact of heart failure hospitalization during follow-up after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. Am J Cardiol 119(11):1729–1739. https://doi.org/10.1016/j.amjcard.2017.03.013

    Article  PubMed  Google Scholar 

  23. Meta-analysis Global Group in Chronic Heart F (2012) The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. Eur Heart J 33(14):1750–1757. https://doi.org/10.1093/eurheartj/ehr254

    Article  Google Scholar 

  24. Khera R, Cram P, Lu X, Vyas A, Gerke A, Rosenthal GE, Horwitz PA, Girotra S (2015) Trends in the use of percutaneous ventricular assist devices: analysis of National Inpatient Sample data, 2007 through 2012. JAMA Intern Med 175(6):941–950. https://doi.org/10.1001/jamainternmed.2014.7856

    Article  PubMed Central  PubMed  Google Scholar 

  25. O'Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, Palacios I, Maini B, Mulukutla S, Dzavik V, Popma J, Douglas PS, Ohman M (2012) A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 126(14):1717–1727. https://doi.org/10.1161/CIRCULATIONAHA.112.098194

    Article  PubMed  Google Scholar 

  26. Goyal P, Paul T, Almarzooq ZI, Peterson JC, Krishnan U, Swaminathan RV, Feldman DN, Wells MT, Karas MG, Sobol I, Maurer MS, Horn EM, Kim LK (2017) Sex- and race-related differences in characteristics and outcomes of hospitalizations for heart failure with preserved ejection fraction. J Am Heart Assoc 6(4). https://doi.org/10.1161/JAHA.116.003330

  27. Ziaeian B, Heidenreich PA, Xu H, DeVore AD, Matsouaka RA, Hernandez AF, Bhatt DL, Yancy CW, Fonarow GC (2017) Race/ethnic differences in outcomes among hospitalized Medicare patients with heart failure and preserved ejection fraction. JACC Heart Fail 5(7):483–493. https://doi.org/10.1016/j.jchf.2017.02.012

    Article  PubMed Central  PubMed  Google Scholar 

  28. Gershlick AH, Khan JN, Kelly DJ, Greenwood JP, Sasikaran T, Curzen N, Blackman DJ, Dalby M, Fairbrother KL, Banya W, Wang D, Flather M, Hetherington SL, Kelion AD, Talwar S, Gunning M, Hall R, Swanton H, McCann GP (2015) Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol 65(10):963–972. https://doi.org/10.1016/j.jacc.2014.12.038

    Article  PubMed Central  PubMed  Google Scholar 

  29. Burkhoff D (2012) Mortality in heart failure with preserved ejection fraction: an unacceptably high rate. Eur Heart J 33(14):1718–1720. https://doi.org/10.1093/eurheartj/ehr339

    Article  PubMed  Google Scholar 

  30. Center on Budget and Policy Priorities. Similarities among Senate H, and Trump budget plans outweigh their differences. https://www.cbpp.org/research/federal-budget/similarities-among-senate-house-and-trump-budget-plans-outweigh-their. Accessed on December 11, 2017

  31. Congressional Budget Office. Preliminary analysis of legislation that would replace subsidies for health care with block grants. https://www.cbo.gov/publication/53126. Accessed on December 6

  32. Kelly JP, Mentz RJ, Mebazaa A, Voors AA, Butler J, Roessig L, Fiuzat M, Zannad F, Pitt B, O'Connor CM, Lam CSP (2015) Patient selection in heart failure with preserved ejection fraction clinical trials. J Am Coll Cardiol 65(16):1668–1682. https://doi.org/10.1016/j.jacc.2015.03.043

    Article  PubMed Central  PubMed  Google Scholar 

  33. de Boer RA, Nayor M, deFilippi CR, Enserro D, Bhambhani V, Kizer JR, Blaha MJ, Brouwers FP, Cushman M, Lima JAC, Bahrami H, van der Harst P, Wang TJ, Gansevoort RT, Fox CS, Gaggin HK, Kop WJ, Liu K, Vasan RS, Psaty BM, Lee DS, Hillege HL, Bartz TM, Benjamin EJ, Chan C, Allison M, Gardin JM, Januzzi JL Jr, Shah SJ, Levy D, Herrington DM, Larson MG, van Gilst WH, Gottdiener JS, Bertoni AG, Ho JE (2018) Association of cardiovascular biomarkers with incident heart failure with preserved and reduced ejection fraction. JAMA Cardiol 3:215–224. https://doi.org/10.1001/jamacardio.2017.4987

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Funding source

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St W11, Reno, NV, 89502, USA

    Rajkumar Doshi

  2. Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY, USA

    Krunalkumar Patel & Perwaiz Meraj

  3. Department of Internal Medicine, University of South Alabama, Mobile, AL, USA

    Neelesh Gupta

  4. Department of Cardiology, Mediclinic Al Jowhara Hospital, Al Ain, United Arab Emirates

    Rajeev Gupta

Authors
  1. Rajkumar Doshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Krunalkumar Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neelesh Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rajeev Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Perwaiz Meraj
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rajkumar Doshi.

Ethics declarations

Conflicts of interest

The authors report no relationships that could be construed as a conflict of interest.

Electronic supplementary material

ESM 1

(DOCX 11922 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • 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