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Background: Identification and clinical impact of preserved left ventricular ejection fraction (LVEF) on in-hospital outcomes in patients with acute decompensated heart failure (HF) remain poorly defined., Objective: To describe clinical predictors and in-hospital outcomes of acute decompensated HF patients and preserved LVEF, and to develop a clinically-based predictive rule based on data acquired on admission., Methods: Consecutive admissions for HF (n=721) at a tertiary care hospital were followed up to discharge or death. More than 80 clinical variables were evaluated to identify predictors of preserved LVEF upon admission., Results: Preserved LVEF (>50%) was identified in 224 (31%) hospitalizations. Clinical predictors of preserved LVEF were age > 70 years old (p=0.04), female gender (p<0.001), non-ischemic etiology (p<0.001), atrial fibrillation or flutter (p=0.001), anemia (p=0.001), pulse pressure > 45 mmHg (p<0.01) and absence of EKG conduction abnormalities (p<0.001). A clinical score based on these variables was accurate to predict preserved LVEF upon hospital admission (area under ROC curve of 0.76). No significant differences were observed on in-hospital mortality or clinical complications according to quintiles of LVEF., Conclusion: Preserved LVEF is a prevalent and morbid condition among hospitalized HF patients. Simple clinical data obtained on admission might be useful for predicting preserved LVEF.

Objective: To describe non-pharmacological management of patients admitted with heart failure (HF) in a teaching hospital., Methods: A cohort longitudinal study of patients diagnosed with HF according to the Boston score. Within the first 72 hours of admission, the nursing staff of the HF clinic conducted structured interviews and medical chart reviews., Results: Two hundred and eighty-three admissions of 239 patients (age = 64 +/- 15 years) were evaluated; approximately 50% of the patients were male and 37% had heart failure of ischemic etiology Non-pharmacological measures included salt restriction in 97%, urine output monitoring in 85%, fluid balance in 75%, weight monitoring in 61%, and fluid restriction in only 25% of the patients. However, they were often not carried out by the team in charge (p < 0.01 for all comparisons). Irregular use of prescribed drugs in the week prior to admission was 22% and 21% in non-readmitted and readmitted patients, respectively (p = 1.00). Readmitted patients (n = 38) had severe systolic dysfunction, more previous hospitalizations, and longer duration of HF symptoms, as compared to those non-readmitted; in addition they had better knowledge related to self-care (p values < 0.05). In the multivariate analysis, only duration of symptoms remained as an independent predictor of re-admissions., Conclusion: Our data suggest that, even at a teaching hospital, important gaps exist between prescribing non-pharmacological measures for HF patients and their being carried out. Readmitted patients seem to have good understanding of their condition; this finding, however, is significantly associated with HF severity and time of onset.