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. 2021 Aug;117(2):300-306.
doi: 10.36660/abc.20190912.

Characteristics and Temporal Trends in the Mortality of Different Heart Failure Phenotypes in Primary Care

[Article in English, Portuguese]
Antonio José Lagoeiro Jorge  1 , Leticia Mara Dos Santos Barbetta  1 , Eduardo Thadeu de Oliveira Correia  1 , Wolney de Andrade Martins  1 , Adson Renato Leite  1 , Maria Auxiliadora Nogueira Saad  1 , Márcia Maria Sales Dos Santos  1 , Dayse Mary Correia  1 , Maria Luiza Garcia Rosa  1 , Sérgio Chermont  1 , Cárita Cunha Dos Santos  1 , Evandro Tinoco Mesquita  1   2
Affiliations

Characteristics and Temporal Trends in the Mortality of Different Heart Failure Phenotypes in Primary Care

[Article in English, Portuguese]
Antonio José Lagoeiro Jorge et al. Arq Bras Cardiol. 2021 Aug.

Abstract
in English, Portuguese

Background: The classification of heart failure (HF) by phenotypes has a great relevance in clinical practice.

Objective: The study aimed to analyze the prevalence, clinical characteristics, and outcomes between HF phenotypes in the primary care setting.

Methods: This is an analysis of a cohort study including 560 individuals, aged ≥ 45 years, who were randomly selected in a primary care program. All participants underwent clinical evaluations, b-type natriuretic peptide (BNP) measurements, electrocardiogram, and echocardiography in a single day. HF with left ventricular ejection fraction (LVEF) < 40% was classified as HF with reduced ejection fraction (HFrEF), LVEF 40% to 49% as HF with mid-range ejection fraction (HFmrEF) and LVEF ≥ 50% as HF with preserved ejection fraction (HFpEF). After 5 years, the patients were reassessed as to the occurrence of the composite outcome of death from any cause or hospitalization for cardiovascular disease.

Results: Of the 560 patients included, 51 patients had HF (9.1%), 11 of whom had HFrEF (21.6%), 10 had HFmrEF (19.6%) and 30 had HFpEF (58.8%). HFmrEF was similar to HFpEF in BNP levels (p < 0.001), left ventricular mass index (p = 0.037), and left atrial volume index (p < 0.001). The HFmrEF phenotype was similar to HFrEF regarding coronary artery disease (p = 0.009). After 5 years, patients with HFmrEF had a better prognosis when compared to patients with HFpEF and HFrEF (p < 0.001).

Conclusion: The prevalence of ICFEI was similar to that observed in previous studies. ICFEI presented characteristics similar to ICFEP in this study. Our data show that ICFEi had a better prognosis compared to the other two phenotypes.

Fundamento: A classificação da insuficiência cardíaca (IC) por fenótipos possui grande relevância na prática clínica.

Objetivo: O estudo visou analisar a prevalência, as características clínicas e os desfechos entre os fenótipos de IC no contexto da atenção primária.

Métodos: Trata-se de uma análise de um estudo de coorte que incluiu 560 indivíduos, com idade ≥ 45 anos, que foram selecionados aleatoriamente em um programa de atenção primária. Todos os participantes foram submetidos a avaliações clínicas, dosagem do peptídeo natriurético tipo B (BNP), eletrocardiograma e ecocardiografia em um único dia. A IC com fração de ejeção do ventrículo esquerdo (FEVE) < 40% foi classificado como IC com fração de ejeção reduzida (ICFEr), FEVE de 40% a 49% como IC com fração de ejeção intermediária (ICFEi) e FEVE ≥ 50% como IC com fração de ejeção preservada (ICFEp). Após 5 anos, os pacientes foram reavaliados quanto à ocorrência do desfecho composto de óbito por qualquer causa ou internação por doença cardiovascular.

Resultados: Dos 560 pacientes incluídos, 51 pacientes tinham IC (9,1%), 11 dos quais tinham ICFEr (21,6%), 10 tinham ICFEi (19,6%) e 30 tinham ICFEp (58,8%). A ICFEi foi semelhante à ICFEp nos níveis de BNP (p < 0,001), índice de massa do ventrículo esquerdo (p = 0,037) e índice de volume do átrio esquerdo (p < 0,001). O fenótipo de ICFEi foi semelhante ao de ICFEr em relação à doença arterial coronariana (p = 0,009). Após 5 anos, os pacientes com ICFEi apresentaram melhor prognóstico quando comparados aos pacientes com ICFEp e ICFEr (p < 0,001).

Conclusão: A prevalência de ICFEI foi semelhante ao observado em estudos anteriores. A ICFEI apresentou características semelhantes a ICFEP neste estudo. Nossos dados mostram que a ICFEi teve melhor prognóstico em comparação com os outros dois fenótipos.

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Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

Figura 1
Figura 1. Fluxograma de seleção da população
Figura 2
Figura 2. Curvas de Kaplan-Meier mostram que pacientes com ICFEi tiveram um pior desfecho composto de óbito por todas as causas e internação cardiovascular do que pacientes sem IC (p < 0,007), mas pacientes com ICFEi tiveram melhor prognóstico em comparação com pacientes com ICFEp e ICFEr (p < 0,001). O ICFEr teve o pior prognóstico dos três fenótipos de IC.
IC: insuficiência cardíaca; ICFEi: IC com fração de ejeção intermediária; ICFEp: IC com fração de ejeção preservada; ICFEr: IC com fração de ejeção reduzida.
Figure 1
Figure 1. Population selection flowchart.
Figure 2
Figure 2. Kaplan-Meier curve showing that patients with HFmrEF had a worse composite outcome of all-cause death and cardiovascular hospitalization than patients without HF (p < 0.007), but patients with HFmrEF had better prognosis compared to patients with HFpEF and HFrEF (p < 0.001). HFrEF had the worst prognosis of the three phenotypes of HF. HF: heart failure; HFmrEF: HF with mid-range ejection fraction; HFpEF: HF with preserved ejection fraction; HFrEF: HF with reduced ejection fraction.
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