Document Detail

Systolic versus diastolic heart failure in community practice: clinical features, outcomes, and the use of angiotensin-converting enzyme inhibitors.
MedLine Citation:
PMID:  11099679     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Among patients with heart failure, there is controversy about whether there are clinical features and laboratory tests that can differentiate patients who have low ejection fractions from those with normal ejection fractions. The usefulness of angiotensin-converting enzyme (ACE) inhibitors among heart failure patients who have normal left ventricular ejection fractions is also not known. METHODS: From a registry of 2,906 unselected consecutive patients with heart failure who were admitted to 10 acute-care community hospitals during 1995 and 1997, we identified 1291 who had a quantitative measurement of their left ventricular ejection fraction. Patients were separated into three groups based on ejection fraction: < or =0.39 (n = 741, 57%), 0.40 to 0.49 (n = 238, 18%), and > or =0.50 (n = 312, 24%). In-hospital mortality, prescription of ACE inhibitors at discharge, subsequent rehospitalization, quality of life, and survival were measured; survivors were observed for at least 6 months after hospitalization. RESULTS: The mean (+/- SD) age of the sample was 75+/-11 years; the majority (55%) of patients were women. In multivariate models, age >75 years, female sex, weight >72.7 kg, and a valvular etiology for heart failure were associated with an increased probability of having an ejection fraction > or =0.50; a prior history of heart failure, an ischemic or idiopathic cause of heart failure, and radiographic cardiomegaly were associated with a lower probability of having an ejection fraction > or =0.50. Total mortality was lower in patients with an ejection fraction > or =0.50 than in those with an ejection fraction < or =0.39 (odds ratio [OR] = 0.69, 95% confidence interval [CI 0.49 to 0.98, P = 0.04). Among hospital survivors with an ejection fraction of 0.40 to 0.49, the 65% who were prescribed ACE inhibitors at discharge had better mean adjusted quality-of-life scores (7.0 versus 6.2, P = 0.02), and lower adjusted mortality (OR = 0.34, 95% CI: 0.17 to 0.70, P = 0.01) during follow-up than those who were not prescribed ACE inhibitors. Among hospital survivors with an ejection fraction > or =0.50, the 45% who were prescribed ACE inhibitors at discharge had better (lower) adjusted New York Heart Association (NYHA) functional class (2.1 versus 2.4, P = 0.04) although there was no significant improvement in survival. CONCLUSIONS: Among patients treated for heart failure in community hospitals, 42% of those whose ejection fraction was measured had a relatively normal systolic function (ejection fraction > or 0.40). The clinical characteristics and mortality of these patients differed from those in patients with low ejection fractions. Among the patients with ejection fractions > or =0.40, the prescription of ACE inhibitors at discharge was associated favorable effects.
E F Philbin; T A Rocco; N W Lindenmuth; K Ulrich; P L Jenkins
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of medicine     Volume:  109     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  2000 Dec 
Date Detail:
Created Date:  2000-12-06     Completed Date:  2000-12-14     Revised Date:  2010-03-23    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  605-13     Citation Subset:  AIM; IM    
Section of Heart Failure and Cardiac Transplantation (EFP), Henry Ford Hospital, Detroit, Michigan, USA.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Diastole / drug effects
Drug Prescriptions / statistics & numerical data
Heart Failure / drug therapy*,  mortality,  physiopathology*
Hospital Mortality
Hospitals, Community
Middle Aged
Patient Readmission
Quality of Life
Stroke Volume / drug effects*
Survival Analysis
Systole / drug effects
Time Factors
Treatment Outcome
United States
Ventricular Function, Left / drug effects*
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors
Comment In:
Am J Med. 2000 Dec 1;109(8):683-5   [PMID:  11099690 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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