Outcomes of Heart Failure with Reduced, Mildly Reduced, or Preserved Ejection Fraction: the ESC HF III Registry

Background and Aims To assess in-hospital and 1-year cause-specific outcomes in the contemporary European Society of Cardiology (ESC) Heart Failure (HF) III Registry.Methods Patients were enrolled in European or ESC affiliated countries and characterized in detail regarding clinical characteristics and cause-specific outcomes.Results Between 1 November 2018 and 31 December 2020, 10,162 patients were enrolled from 220 centres in 41 countries. Of these, 39% had acute HF ('AHF', age 70 [62-79] years, 36% women) and 61% had out-patient visit for HF ['out-patient HF', age 66 (58-75) years, 33% women]. Overall, 58% had HF with reduced ejection fraction (HFrEF), 17% HF with mildly reduced ejection fraction (HFmrEF), and 25% HF with preserved ejection fraction (HFpEF). In AHF, median [interquartile range (IQR)] duration of hospitalization was 9 (6-14) days, and 5.1% died in hospital (HFrEF 5.2%; HFmrEF 4.8%, HFpEF 3.4%). In AHF discharged alive and in out-patient HF, after a median (IQR) follow-up of 376 (360-432) days, all-cause, cardiovascular (CV), and unknown-cause mortality rates per 100 patient-years were as follows: AHF HFrEF: 19, 13, and 3.0 per 100 patient-years. The corresponding numbers were in AHF HFmrEF: 22, 11, and 6.3; AHF HFpEF: 16, 7.0, and 4.7; out-patient HFrEF: 6.6, 4.3, and 0.9; out-patient HFmrEF: 4.0, 2.6, and 0.8; out-patient HFpEF: 3.9, 1.7, and 1.2. At least one (re-)hospitalization for HF was experienced in 44% AHF HFrEF, 42% AHF HFmrEF, 36% AHF HFpEF, 21% out-patient HFrEF, 14% out-patient HFmrEF, and 18% out-patient HFpEF.Conclusions In HF in Europe and affiliated countries, in-hospital mortality was 5.1% and greater with lower ejection fraction. Among hospital survivors and out-patients over 1 year of follow-up, event rates per 100 patient-years varied for death, 3.9-22, CV death 1.7-13, and unknown cause of death 0.8-6.3. The percent of patients that were (re-)hospitalized for HF at least once over 1-year follow-up ranged 14-44% and was twice as high post-AHF compared with post-out-patient visit.