BACKGROUND Outcomes of hospitalized patients with heart failure (HF) and characteristics of advanced HF stage may vary across left ventricular ejection fraction (LVEF) and world regions. OBJECTIVES This study sought to analyze characteristics of hospitalized advanced HF patients across LVEF spectrum, world regions, and country income. METHODS Among 18,553 hospitalized patients with acute HF (7,902 new-onset HF and 10,651 decompensated chronic HF) enrolled in the global registry REPORT-HF (International Registry to Assess Medical Practice With Longitudinal Observation for Treatment of Heart Failure), we analyzed characteristics and outcomes of patients with advanced HF, defined as previously diagnosed HF; severe symptoms before current admission (NYHA functional class III/IV); and ≥1 HF-related hospitalization in the preceding 12 months, excluding the current. Differences among hospitalized advanced HF subgroups stratified by LVEF, world region, and country income were examined. RESULTS Among 6,999 patients with decompensated chronic HF and available previous NYHA functional class and HF hospitalization status, 3,397 (48.5%; 18.3% of the total population) had advanced HF. Of these, 44.5% had severely reduced (≤30%), 34.9% mildly/moderately reduced (31%-49%), and 20.7% preserved (≥50%) LVEF. Patients from Eastern Europe had the lowest 1-year mortality (23%), whereas those from Southeast Asia had the highest (37%). Patients from lower-middle-income countries were younger, with shorter HF duration and lower comorbidity prevalence, received fewer beta-blockers and HF-devices, and had higher 1-year mortality (34%) than upper-middle- (26%) or high-income countries (27%; P = 0.018). Adjusted 1-year mortality risk did not differ among LVEF subgroups (all P > 0.05), nor did 1-year HF hospitalization rate (P = 0.56). CONCLUSIONS Hospitalized patients with advanced HF and preserved LVEF had similarly adverse outcomes as those with reduced LVEF. Patients from lower-middle-income countries had less implementation of HF therapies and higher 1-year mortality.

中文翻译：

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左心室射血分数保留与降低的住院晚期心力衰竭：全球视角。


背景 心力衰竭 （HF） 住院患者的结局和晚期 HF 分期的特征可能因左心室射血分数 （LVEF） 和世界地区而异。目的 本研究旨在分析 LVEF 谱、世界地区和国家收入不同住院晚期 HF 患者的特征。方法 在全球登记处 REPORT-HF（通过纵向观察评估医疗实践治疗心力衰竭的国际登记处）登记的 18,553 名急性 HF 住院患者（7,902 名新发 HF 和 10,651 名失代偿性慢性 HF）中，我们分析了晚期 HF 患者的特征和结果，定义为先前诊断的 HF;当前入院前出现严重症状（NYHA 功能分级 III/IV）;以及过去 12 个月内 ≥1 次 HF 相关住院治疗，不包括目前的住院治疗。检查了按 LVEF 、世界地区和国家收入分层的住院晚期 HF 亚组之间的差异。结果 在 6,999 例失代偿期慢性 HF 患者和可用的既往 NYHA 功能分级和 HF 住院状态中，3,397 例 （48.5%;占总人口的 18.3%） 患有晚期 HF。其中，44.5% 严重降低 （≤30%），34.9% 轻度/中度降低 （31%-49%），20.7% 保留 （≥50%） LVEF。东欧患者的 1 年死亡率最低 （23%），而东南亚患者的 1 年死亡率最高 （37%）。来自中低收入国家的患者更年轻，HF 持续时间较短，合并症患病率较低，接受的 β 受体阻滞剂和 HF 装置较少，1 年死亡率 （34%） 高于中高收入国家 （26%） 或高收入国家 （27%;P = 0.018）。调整后的 1 年死亡风险在 LVEF 亚组之间没有差异 （P均 > 0.05），1 年 HF 住院率也没有 （P = 0.56）。结论 晚期 HF 和 LVEF 保留的住院患者与 LVEF 降低的患者具有相似的不良结局。来自中低收入国家的患者接受 HF 治疗的次数较少，1 年死亡率较高。