IJCS | Volume 33, Nº1, January / February 2019

DOI: 10.5935/2359-4802.20190075 Introduction Heart failure (HF) is a clinical syndrome with high global prevalence, responsible for elevated mortality and readmission rates. 1 It is often categorized according to left ventricular ejection fraction (LVEF), historically defined as heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Unlike HFrEF, whose therapy in terms of mortality reduction has been well-defined, HFpEF remains a syndrome that still poses diagnostic challenges, with no well-established treatment. 2 Most HFrEF clinical trials have included patients with EF < 35-40%, whereas HFpEF trials used EF > 50%, EF > 45% or EF > 40% as 45 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2020;33(1):45-54 Mailing Adress: Sílvia Marinho Martins Rua Manuel de Carvalho 262/601. Postal Code: 50050 – 370, Aflitos, Recife, PE – Brazil. E-mail: s.m.martins@uol.com.br Decompensated Heart Failure with Mid-Range Ejection Fraction: Epidemiology and In-Hospital Mortality Risk Factors Gabriela Paiva Cavalcant i, C amila Sartesch i, Glory Eithne Sarinho Gome s, Carolina de Araújo Medeiro s, José Henrique Martins Pimente l, A ndré Rabelo Lafayett e, M aria Celita Almeid a, P aulo Sérgio Rodrigues Oliveir a, S ilvia Marinho Martin s Real Hospital Português de Beneficência em Pernambuco, Recife, PE - Brazil Manuscript received December 18, 2017; revised manuscript October 23, 2018; accepted November 01, 2018. Abstract Background: Recently, a new HF entity, with LVEF between 40-49%, was presented to comprehend and seek better therapy for HF with preserved LVEF (HFpEF) and borderline, in the means that HF with reduced LVEF (HFrEF) already has well-defined therapy in the literature. Objective: To compare the clinical-therapeutic profile of patients with HF with mid-range LVEF (HFmrEF) with HFpEF and HFrEF and to verify predictors of hospital mortality. Method: Historical cohort of patients admitted with decompensated HF at a supplementary hospital in Recife/ PE between April/2007 - August/2017, stratified by LVEF (< 40%/40 - 49/≥ 50%), based on the guideline of the European Society of Cardiology (ESC) 2016. The groups were compared and Logistic Regression was used to identify predictors of independent risk for in-hospital death. Results: A sample of 493 patients, most with HFrEF (43%), HFpEF (30%) and HFmrEF (26%). Average age of 73 (± 14) years, 59% men. Hospital mortality 14%, readmission within 30 days 19%. In therapeutics, it presented statistical significance among the 3 groups, spironolactone, in HFrEF patients. Hospital death and readmission within 30 days did not make difference. In the HFmrEF group, factors independently associated with death were: valve disease (OR: 4.17, CI: 1.01-9.13), altered urea at admission (OR: 6.18, CI: 1.78-11.45) and beta-blocker hospitalization (OR: 0.29, CI: 0.08-0.97). In HFrEF, predictors were: prior renal disease (OR: 2.84, CI: 1.19-6.79), beta- blocker at admission (OR: 0.29, CI: 0.12-0.72) and ACEI/ ARB (OR: 0.21, CI: 0.09-0.49). In HFpEF, only valve disease (OR: 4.61, CI: 1.33-15.96) and kidney disease (OR: 5.18, CI: 1.68-11.98) were relevant. Conclusion: In general, HFmrEF presented intermediate characteristics between HFrEF and HFpEF. Independent predictors of mortality may support risk stratification and management of this group. (Int J Cardiovasc Sci. 2020;33(1):45-54) Keywords: Heart Failure/physiopatology; StrokeVolume/physiology; Prognosis; HospitalMortality; Epidemiology.