Abstract 18870: Adjudicated versus 'Administrative' Heart Failure With Preserved Ejection Fraction

Introduction: The proportion of heart failure (HF) with preserved ejection fraction (HFpEF) is reported to be as high as 40%-60% based on administrative data, but these estimates have not been clinically validated. Methods: We evaluated 1752 consecutive patients who received outpatient care during the first quarter of 2012 for an encounter ICD-9 code of 402.X1, 404.X1, 404.X3, or 428.XX. Medical records were reviewed for HF symptoms, signs, and treatment; last reported ejection fraction (EF); all previous EF documentations; and special causes of HF (congenital heart disease or specific cardiomyopathies). We classified confirmed HF cases not due to special causes into 3 mutually exclusive categories: (1) HFpEF: current EF >40% without any previous EF ≤40%; (2) HF with recovered EF (HFrecEF): current EF >40% but previous EF ≤40%; and (3) HF with reduced EF (HFrEF): current EF ≤40%. Results: HF was confirmed in 1652 cases (94.3%). Among these, 321 had HFpEF (19.4%; 95%CI 17.6-21.4); 268 had HFrecEF (16.2%; 95%CI 14.5-18.1); and 992 had HFrEF (60.0%; 95%CI 57.7-62.4); the remaining 71 cases (4.3%) had HF due to special causes. In comparison, the proportion of HFpEF on the basis of ICD codes and last EF without further adjudication would have been 39.0%. Patient characteristics are summarized in Table 1. After 2 years of follow up, age- and gender- adjusted mortality was 10.2% in HFrEF, 8.6% in HFpEF, and 4.4% in HFrecEF patients (stratified log-rank P=0.005), Fig. 1 . Conclusions: The proportion of clinically verified HFpEF is considerably lower compared to estimates from administrative data. Many patients with preserved EF actually represent HFrecEF, which has a more favorable prognosis.