IJCS | Volume 33, Nº1, January / February 2019

46 inclusion criteria. Other HF studies reported, within large populations, a broad proportion of patients with mid- range LVEF, between 40-50% still poorly characterized. 1-4 In 2013, the American Heart Association (AHA) 5 proposed in its guidelines the inclusion of a new group, HF with borderline EF (EF: 41-49%). Recently, the European Society of Cardiology guidelines has emphasized this new classification, recognizing a new entity of HF with mid-range ejection fraction (HFmrEF), defined as the presence of signs and symptoms of heart failure, EF: 40-49%, elevated natriuretic peptides levels and at least 1 additional criterion: structural heart disease and/or diastolic dysfunction. 6 Until now, there is no consensus on the most appropriate LVEF cut-off to differentiate the HF groups or the prognosis and the real benefits of the treatment in this particular group of HF with mid-range ejection fraction. In view of such a scenario, the objective of this study was to identify and compare the clinical and therapeutic profile of HF patients, stratifying them by LVEF, according with the 2016 European Society of Cardiology (ESC) guidelines, and to identify specific independent predictors of in- hospital mortality in each group. Methods Retrospective hospital-based cohort of patients admitted to a reference hospital of the Supplemental Healthcare System, in Recife/PE, between April 2007 and August 2017. The sample included patients admitted with a diagnosis of decompensated heart failure, aged over 18 years, who had been hospitalized for at least 24 hours, in functional classes III and IV, according to the New York Heart Association (NYHA) functional classification 7 and who had undergone echocardiography at the service or had recent echocardiographic data available (obtained within less than 3 months), including a description of the LVEF. Based on the guideline of the European Society of Cardiology (ESC) 2016 6 and on the Brazilian guidelines published in 2018, 8 patients were divided into 3 distinct groups of HF, according to LVEF on echocardiogram: HFrEF (EF<40%), HFmrEF (EF: 40 - 49%) and HFpEF (≥ 50%). LVEF was calculated by echocardiography, using the Teichholz’ M-mode volume method, or the modified Simpson’s formula for measurement of LV end-systolic and end-diastolic diameter, in the 4-chamber apical plane, in accordance with current guidelines, all performed in the echocardiography sector of the hospital. 9 Data collection included hospital admission data, in- hospital mortality data and readmission within 30 days. The information were obtained from the consultation of medical records and complemented, whenever necessary, by contact with the assisting physician. A structured questionnaire was chosen as data collection instrument, including demographic and clinical variables, clinical exam at admission, complementary exams and the treatment adopted. The outcome of interest was in- hospital mortality. The etiology of HF and the cause of decompensation were defined by the assistant physician onmedical report. Ischemic, hypertensive, valvular, idiopathic, and other etiologies (lower proportion group or with no confirmed diagnosis by the assistant physician) were investigated. Some continuous variables were changed into categories for analytical purposes; 10 age (< 65 and ³ 65 years), systolic blood pressure (SBP < 115 mmHg and ³ 115 mmHg), heart rate (£ 80 bpm and > 80 bpm), serum creatinine (altered: > 1,3 mg/dl men and > 1,1 mg/dl women), plasma sodium (altered: < 130 mEq/l) and urea (altered: ³ 92mg/dl). The presence of anemia was defined, according to the WHO criteria (Hb < 13.0 g/dL in men and Hb < 12.0 g/dL in women). 11 Statistical Analysis Demographic and clinical characteristics of patients were analyzed using descriptive statistics: mean and standard deviation (SD) for quantitative variables and absolute and relative frequencies for qualitative variables. Data normality was verified using the Kolmogorov- Smirnov test. To compare the LVEF groups, in relation to the qualitative variables, the Qui-square test was utilized, and, for quantitative variables, analysis of variance methodology was used for normal distribution, Kruskal-Wallis test for not normal. Bivariate analysis, using Pearson’s Chi-square, was carried out as a strategy to assess the relation between the outcome (in-hospital death) and the independent variables, studied for each group individually. All variables related to in-hospital death with a p value < 0.20 in the bivariate analysis were considered for inclusion in multiple logistic regression model. The stepwise forward method was used to select the final model. Once the final model was chosen, calibration was assessed using Hosmer Lemeshow›s goodness of fit test. The IBMSPSS Statistics for Windows Cavalcanti et al. Decompensated heart failure with intermediate ejection fraction Int J Cardiovasc Sci. 2020;33(1):45-54 Original Article