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.