Table 1.
Characteristics of Patients with Advanced Heart Failure
| Overall Advanced HF (N=936) | Advanced HFrEF (N=396) | Advanced HFmrEF (N=134) | Advanced HFpEF (N=406) | P-value | |||||
|---|---|---|---|---|---|---|---|---|---|
| Demographics | |||||||||
| Age, mean (SD) | 76.9 (14.6) | 73.9 (15.9) | 80.4 (10.9) | 78.6 (13.8) | <0.001 | ||||
| Male, n (%) | 519 (55.5) | 286 (72.2) | 77 (57.5) | 156 (38.4) | <0.001 | ||||
| White Race, n (%) | 876 (93.7) | 367 (92.9) | 132 (98.5) | 377 (92.9) | 0.46 | ||||
| Hispanic ethnicity, n (%) | 15 (1.6) | 4 (1.0) | 4 (3.0) | 7 (1.7) | 0.28 | ||||
| Married/partner, n (%) | 438 (50.8) | 217 (60.1) | 60 (47.2) | 161 (42.9) | <0.001 | ||||
| Comorbidities a | |||||||||
| Obese (≥30), n (%) | 401 (43.3) | 152 (39.0) | 58 (43.6) | 191 (47.3) | |||||
| Hypertension, n (%) | 829 (88.6) | 326 (82.3) | 127 (94.8) | 376 (92.6) | <0.001 | ||||
| Hyperlipidemia, n (%) | 684 (73.1) | 280 (70.7) | 107 (79.9) | 297 (73.2) | 0.12 | ||||
| CAD, n (%) | 661 (70.6) | 308 (77.8) | 110 (82.1) | 243 (59.9) | <0.001 | ||||
| Diabetes, n (%) | 415 (44.3) | 164 (41.4) | 66 (49.3) | 185 (45.6) | 0.23 | ||||
| COPD, n (%) | 537 (57.4) | 199 (50.3) | 70 (52.2) | 268 (66.0) | <0.001 | ||||
| PVD, n (%) | 487 (52.0) | 191 (48.2) | 79 (59.0) | 217 (53.5) | 0.08 | ||||
| CVD, n (%) | 217 (23.2) | 82 (20.7) | 37 (27.6) | 98 (24.1) | 0.22 | ||||
| Dementia, n (%) | 65 (6.9) | 23 (5.8) | 10 (7.5) | 32 (7.9) | 0.50 | ||||
| Depression, n (%) | 257 (27.5) | 91 (23.0) | 43 (32.1) | 123 (30.3) | 0.03 | ||||
| Charlson index, mean (SD) | 5.0 (2.5) | 4.8 (2.5) | 5.5 (2.4) | 5.0 (2.5) | 0.02 | ||||
| Medications at Advanced HF | |||||||||
| ACE/ARB/ARNI | 576 (61.5) | 264 (66.7) | 84 (62.7) | 228 (56.2) | 0.036 | ||||
| Beta blocker | 699 (74.7) | 294 (74.2) | 112 (82.6) | 293 (72.3) | 0.030 | ||||
| MRA | 146 (15.6) | 75 (18.9) | 20 (14.9) | 51 (12.6) | 0.044 | ||||
| Labs | |||||||||
| <134, n (%) | 163 (17.4) | 61 (15.4) | 27 (20.2) | 75 (18.5) | |||||
| Creatinine, mean (SD) | 1.59 (0.97) | 1.64 (1.05) | 1.62 (0.98) | 1.53 (0.89) | 0.21 | ||||
| ≥60, n (%) | 263 (28.1) | 123 (31.1) | 37 (27.6) | 103 (25.4) | |||||
| B-type natriuretic peptide, median (IQR)b | 1011 (532, 1671) | 1099 (625, 1783) | 1510 (763, 2110) | 743 (309, 1227) | <0.001 | ||||
| NT-pro-BNP, median (IQR)b | 5699 (2841, 12740) | 8334 (3942, 15917) | 5610 (2964, 15028) | 4258 (2166, 8714) | <0.001 | ||||
| Anemia, n (%) | 664 (70.9) | 266 (67.2) | 103 (76.9) | 295 (72.7) | 0.06 | ||||
| >1.5, n (%) | 82 (10.2) | 52 (14.4) | 8 (7.1) | 22 (6.7) | |||||
| <3.3, n (%) | 248 (32.0) | 97 (29.4) | 50 (42.7) | 101 (30.7) | |||||
| Echo Criteria for Advanced HF | |||||||||
| Moderate or more RV dysfunction, n (%) | 294 (31.4) | 174 (43.9) | 32 (23.9) | 88 (21.7) | <0.001 | ||||
| Severe valvular stenosis/ regurgitation, n(%) | 227 (24.3) | 97 (24.5) | 26 (19.4) | 104 (25.6) | 0.34 | ||||
| Severe diastolic dysfunction criteriac, n(%) | 706 (75.4) | 276 (69.7) | 117 (87.3) | 313 (77.1) | <0.001 | ||||
| Severe congenital heart disease, n (%) | 14 (1.5) | 5 (1.3) | 3 (2.2) | 6 (1.5) | 0.72 | ||||
| ≥50%, n (%) | 387 (52.4) | 50 (16.8) | 42 (39.3) | 295 (88.3) | |||||
ACE/ARB/ARNI= angiotensin converting enzyme inhibitor/ angiotensin receptor blocker/ angiotensin receptor neprilysin inhibitor, BMI= body mass index, CAD= coronary artery disease, COPD= chronic obstructive pulmonary disease, CVD= cerebrovascular disease, eGFR= estimated glomerular filtration rate, HFmrEF= heart failure with mid-range ejection fraction, HFrEF= heart failure with reduced ejection fraction, HFpEF= heart failure with preserved ejection fraction, IQR= interquartile range, PVD= peripheral vascular disease, MRA= mineralocorticoid receptor antagonist, RV= right ventricular, SD= standard deviation
Comorbidities are defined as having 2 codes >30 days apart during the 5 year prior to advanced HF diagnosis. Hypertension, hyperlipidemia, CAD, and depression are based on DHHS code sets; diabetes, COPD, PVD, CVD, and dementia are based on Charlson code sets.
Missing data: 9 patients were missing BMI, 133 bilirubin, 160 albumin, 194 NTproBNP, 715 BNP, 126 missing EF at incident HF
See supplemental Table 1 for severe diastolic dysfunction criteria used to define advanced HF