Comparative study on characteristics of congestive heart failure patients with preserved versus abnormal left ventricular systolic function and evaluation effects of therapy

Abstract

Objective: To compare clinical characteristics and effects of therapy for hospitalized patients with congestive heart failure (CHF) and different left ventricular ejection fraction (LVEF) during hospitalization. Methods: The medical records of 1 074 unselected conse cutive patients with CHF who were admitted to Queen Mary Hospital from January, 2001 to January, 2002 were retrospectively reviewed. Three hundred and ninety-nine patients were categorized as having either normal left ventricular systolic function or systolic dysfunction based on the results of echocardiography. Clinical features with a slightly modified version of the Framingham criteria, laboratory results and drug therapies at discharge were compared. Results: Among patients, the majo rity were women, 95.5% were ≥65 years and 50.6% ≥80 years of age. Classification of the severity of heart failure showed that 70.2% were New York Heart Association (NYHA) III and IV. Only 399 patients had borderline LVEF at the time of hospitalization, of these patients 191 (47.9%) had preserved systolic function (LVEF ≥ 0.50), and 208 (52.1%) with LVEF < 0.50. Patients with LVEF ≥0.50, who tended to be elderly and more often female, exhibited a lower incidence of coronary artery disease and diabetes than patients with LVEF <0.50 (all P<0.05). Patients with preserved systolic function had a significantly higher prevalence of auricular fibrillation (P<0.05), accounting for up to 84 patients (44.0%) with it, and number of hospitalization for CHF increased. Among patients with systolic dysfunction, 22.6% were discharged on a therapeutic regimen of digoxin, 63.0% on an angiotensin-converting enzyme inhibitor (ACEI), and 12.0% on a β - blocker, 13.9% on a calcium channel blocker. These accounted for 62.3%, 35.1%, 9.4% and 18.3% in patients with preserved systolic function, respectively. There was a higher incidence of use of digoxin (P < 0.05). Conclusion: In hospitalized patients with heart failure, th e clinical signs and symptoms of chronic heart failure are similar to those of patients with CHF, LVEF is a powerful prognostic predictor to distinguish CHF patients with normal systolic function from those with systolic dysfunction. Criteria for use of ACEI and β-blocker are still not clear cut. It is important to differentiate CHF patients with LVEF < 0.50 from that with LVEF ≥0.50 in order to achieve a better therapeutic result in the treatment of CHF.