Prognostic Impact of Cardiovascular versus Noncardiovascular Hospitalizations in Heart Failure with Preserved Ejection Fraction: Insights from TOPCAT

• Published in: Journal of cardiac failure 2022-09, Vol.28 (9), p.1390-1397
• Main Authors: Barkoudah, Ebrahim, Claggett, Brian L, Lewis, Eldrin F, O'Meara, Eileen, Clausell, Nadine, Diaz, Rafael, Fleg, Jerome L, Pitt, Bertram, Rouleau, Jean L., Solomon, Scott D, Pfeffer, Marc A, Desai, Akshay S
• Format: Article
• Language: English
• Subjects: all-cause hospitalizations; comorbidities; heart failure with preserved ejection fraction; mortality; multi-morbidities; prognosis
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.05.004

•How this work applies to patients with HFpEF:•We observed a similar prognostic impact of cardiovascular (CV) vs. noncardiovascular (non-CV) hospitalizations on subsequent mortality in stable outpatients with heart failure with preserved ejection fraction (HFpEF)•Given the high burden of non-CV hospitalizations in the HFpEF population, targeted management of comorbid medical illness (both CV and non-CV) may be critical to reducing morbidity and mortality•Based on the findings from our study, the optimization of the care during both CV and non-CV hospitalizations could offer important clinical benefits in patients with HFpEF : Patients with heart failure (HF) with preserved ejection fraction (HFpEF) are commonly admitted to the hospital for both cardiovascular (CV) and noncardiovascular (non-CV) reasons. The prognostic implications of non-CV hospitalizations in this population are not well understood. In this study, we aimed to examine the prognostic implications of hospitalizations due to CV and non-CV reasons in a HFpEF population. : The Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial (TOPCAT) randomized 3,445 stable outpatients with chronic HF with left ventricular ejection fraction >=45% and either prior hospitalization for HF or elevated natriuretic peptides to treatment with spironolactone or placebo. Hospitalizations for any cause were reported by investigators during study follow-up and characterized according to prespecified category causes. This analysis focused on the subset of TOPCAT participants enrolled in the Americas (N=1,767), in which 2,973 hospitalizations were observed in 1,062 subjects (60%) over a mean follow-up of 3.3 years of study follow-up, of which 1,474 (49%) were ascribed to CV causes. Among 1,056 first hospitalizations, 478 (45%) were for CV reasons and 578 (55%) for non-CV reasons. Mortality rates were lowest for participants not hospitalized during the trial (3.2 per 100 patient-years (PY)), but similarly elevated following first hospitalization for CV and non-CV reasons (11.0 per 100 PY vs. 12.6 per 100 PY, respectively, p=0.24). Among those hospitalized for CV reasons, mortality rates were similar following hospitalization for HF and non-CV related reasons (15.2 per 100 PY vs. 12.6 per 100 PY, p=0.23). Recurrent hospitalization, whether due to CV or non-CV causes, was associated with heightened risk for subsequent mortality, with similar death rates following hospitalization twice