Relevance of left ventricular ejection fraction in the stratification of patients with heart failure: A nationwide picture - 30/10/26
Graphical abstract |
Highlights |
• | LVEF-based HF categories showed distinct profiles and outcomes nationwide. |
• | HFmrEF had intermediate traits and better adjusted survival than HFrEF. |
• | Evidence-based triple therapy is prescribed infrequently in real-life practice. |
• | Cardiologist follow-up is rare for patients with HF, regardless of LVEF category. |
• | LVEF tripartite classification still informs HF care and risk stratification. |
Abstract |
Background |
The management of heart failure relies on categorizing patients by left ventricular ejection fraction: reduced (HFrEF), mildly reduced (HFmrEF) or preserved (HFpEF).
Aims |
This study aimed to examine the characteristics, management and outcomes across left ventricular ejection fraction categories within a large real-world cohort.
Methods |
Using the French national health database, adults hospitalized at least once for heart failure in 2019 with a left ventricular ejection fraction coding were identified. Characteristics, including demographics, comorbidities, medications and medical consultations, were described. Clinical outcomes, including all-cause mortality, all-cause hospitalization and heart failure-related hospitalization, were assessed across left ventricular ejection fraction categories using Cox multivariable analyses.
Results |
Of 27,294 patients, 37% had HFrEF, 20% had HFmrEF and 43% had HFpEF. Patients with HFpEF were older and more comorbid than those with HFrEF; patients with HFmrEF showed intermediate features. Adjusted analyses found that the HFmrEF and HFpEF categories had lower risks of all-cause mortality (hazard ratio 0.71, 95% confidence interval 0.63–0.80 and hazard ratio 0.65, 95% confidence interval 0.60–0.72, respectively) and heart failure hospitalization (hazard ratio 0.65, 95% confidence interval 0.59–0.72 and hazard ratio 0.89, 95% confidence interval 0.82–0.96, respectively) compared with the HFrEF category. Although polypharmacy was frequent – ranging from 53% in the HFrEF category to 65% in the HFpEF category receiving at least 10 drugs – only 24% of patients with HFrEF received guideline-recommended heart failure triple therapy. The mean annual rate of cardiologist consultations remained low – nearly one per patient – regardless of left ventricular ejection fraction.
Conclusions |
In our nationwide study, left ventricular ejection fraction categories were associated with distinct patient profiles and outcomes, supporting the tripartite categorization. There was notable underuse of guideline-directed heart failure therapy, despite widespread polypharmacy, and infrequent specialist follow-up, underscoring the need for strategies to improve heart failure management in clinical practice.
Le texte complet de cet article est disponible en PDF.Keywords : Heart failure, Left ventricular ejection fraction, Risk stratification, Guideline-directed medical therapy, Claims database
Plan
Vol 119 - N° 10
janvier 2026 Retour au numéro
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