Predictors of Two-year Mortality in Asian Patients with Heart Failure and Preserved Ejection Fraction Jonathan Yap, David Sim, Choon Pin Lim, Shaw Yang Chia, Yun Yun Go, Fazlur Rehman Jaufeerally, Ling Ling Sim, Reginald Liew, Chi-Keong Ching PII: DOI: Reference:
S0167-5273(15)00090-X doi: 10.1016/j.ijcard.2015.01.063 IJCA 19624
To appear in:
International Journal of Cardiology
Received date: Revised date: Accepted date:
3 October 2014 9 December 2014 25 January 2015
Please cite this article as: Yap Jonathan, Sim David, Lim Choon Pin, Chia Shaw Yang, Go Yun Yun, Jaufeerally Fazlur Rehman, Sim Ling Ling, Liew Reginald, Ching Chi-Keong, Predictors of Two-year Mortality in Asian Patients with Heart Failure and Preserved Ejection Fraction, International Journal of Cardiology (2015), doi: 10.1016/j.ijcard.2015.01.063
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Predictors of Two-year Mortality in Asian Patients with Heart Failure and Preserved Ejection Fraction
PT
Jonathan Yap MBBS, MRCP1, David Sim MBBS, MRCP 1, Choon Pin Lim MBBS, MRCP 1, Shaw Yang Chia1, Yun Yun Go MBBS, MRCP 1, Fazlur Rehman Jaufeerally
RI
MBBS, MRCP 2, Ling Ling Sim1, Reginald Liew MBBS, MRCP 3, Chi-Keong Ching
SC
MBBS, MRCP 1,3
Department of Cardiology, National Heart Centre Singapore
2
Department of Internal Medicine, Singapore General Hospital
3
Duke-NUS Graduate Medical School, Singapore
MA
NU
1
TE
Dr Chi-Keong Ching
D
Corresponding author:
AC CE P
National Heart Centre Singapore
Mistri Wing, 17 Third Hospital Avenue Singapore 168752
Tel. +65 67048963
Fax. +65 68449069
Email: [email protected]
1
ACCEPTED MANUSCRIPT ABSTRACT
PT
Introduction
RI
Mortality in patients with heart failure and preserved ejection fraction (HFpEF) remains high. Data from Asia is lacking. We aim to study the impact of ethnicity and other
NU
SC
predictors of mortality in patients admitted for HFpEF in a multi-ethnic Asian country.
Material and methods
MA
Consecutive patients admitted to two local institutions with heart failure and ejection fraction ≥50% on transthoracic echocardiogram from Jan 2008 to Dec 2009 were
TE
D
included. All patients were followed-up for 2 years. Overall mortality was obtained from
Results
AC CE P
the national registry of deaths in our country.
A total of 1960 patients with heart failure were included. 751 (38.3%) patients had HFpEF. Overall mortality at two years was 26.6% (n=200) compared to 37.1% (n=449) in patients with reduced ejection fraction (HR 0.618 (95% CI 0.508-0.753), p 220pg/ml. 55 patients were
MA
excluded due to incomplete follow-up; 93 patients with no recent documented EF and 68
TE
D
patients with EF≥50% that did not fulfill the criteria were excluded.
Outcomes
AC CE P
All mortality data in Singapore are kept by the National Registry of Diseases Office (NRDO). All patients were followed-up for 2 years. Mortality data and cause of death was obtained from NRDO. Primary outcome measure was 2-year all-cause mortality and secondary outcome measures were 2-year cardiovascular mortality, in-hospital mortality and length of stay.
Statistical Analysis Data was analyzed using the Statistical Package for the Social Sciences (SPSS®, version 16.0). The demographic and risk factor profile of the study population was characterized using descriptive statistics. All parameters analysed were taken at admission with the exception of medications which were taken on discharge. The 2 test was used to
6
ACCEPTED MANUSCRIPT compare categorical variables and the t-test used to investigate the relationship between continuous variables between the 2 groups. Cox proportional hazard modeling was
PT
applied to all-cause and cardiovascular mortality. Variables significant on univariate
RI
analysis (p
S0167-5273(15)00090-X doi: 10.1016/j.ijcard.2015.01.063 IJCA 19624
To appear in:
International Journal of Cardiology
Received date: Revised date: Accepted date:
3 October 2014 9 December 2014 25 January 2015
Please cite this article as: Yap Jonathan, Sim David, Lim Choon Pin, Chia Shaw Yang, Go Yun Yun, Jaufeerally Fazlur Rehman, Sim Ling Ling, Liew Reginald, Ching Chi-Keong, Predictors of Two-year Mortality in Asian Patients with Heart Failure and Preserved Ejection Fraction, International Journal of Cardiology (2015), doi: 10.1016/j.ijcard.2015.01.063
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Predictors of Two-year Mortality in Asian Patients with Heart Failure and Preserved Ejection Fraction
PT
Jonathan Yap MBBS, MRCP1, David Sim MBBS, MRCP 1, Choon Pin Lim MBBS, MRCP 1, Shaw Yang Chia1, Yun Yun Go MBBS, MRCP 1, Fazlur Rehman Jaufeerally
RI
MBBS, MRCP 2, Ling Ling Sim1, Reginald Liew MBBS, MRCP 3, Chi-Keong Ching
SC
MBBS, MRCP 1,3
Department of Cardiology, National Heart Centre Singapore
2
Department of Internal Medicine, Singapore General Hospital
3
Duke-NUS Graduate Medical School, Singapore
MA
NU
1
TE
Dr Chi-Keong Ching
D
Corresponding author:
AC CE P
National Heart Centre Singapore
Mistri Wing, 17 Third Hospital Avenue Singapore 168752
Tel. +65 67048963
Fax. +65 68449069
Email: [email protected]
1
ACCEPTED MANUSCRIPT ABSTRACT
PT
Introduction
RI
Mortality in patients with heart failure and preserved ejection fraction (HFpEF) remains high. Data from Asia is lacking. We aim to study the impact of ethnicity and other
NU
SC
predictors of mortality in patients admitted for HFpEF in a multi-ethnic Asian country.
Material and methods
MA
Consecutive patients admitted to two local institutions with heart failure and ejection fraction ≥50% on transthoracic echocardiogram from Jan 2008 to Dec 2009 were
TE
D
included. All patients were followed-up for 2 years. Overall mortality was obtained from
Results
AC CE P
the national registry of deaths in our country.
A total of 1960 patients with heart failure were included. 751 (38.3%) patients had HFpEF. Overall mortality at two years was 26.6% (n=200) compared to 37.1% (n=449) in patients with reduced ejection fraction (HR 0.618 (95% CI 0.508-0.753), p 220pg/ml. 55 patients were
MA
excluded due to incomplete follow-up; 93 patients with no recent documented EF and 68
TE
D
patients with EF≥50% that did not fulfill the criteria were excluded.
Outcomes
AC CE P
All mortality data in Singapore are kept by the National Registry of Diseases Office (NRDO). All patients were followed-up for 2 years. Mortality data and cause of death was obtained from NRDO. Primary outcome measure was 2-year all-cause mortality and secondary outcome measures were 2-year cardiovascular mortality, in-hospital mortality and length of stay.
Statistical Analysis Data was analyzed using the Statistical Package for the Social Sciences (SPSS®, version 16.0). The demographic and risk factor profile of the study population was characterized using descriptive statistics. All parameters analysed were taken at admission with the exception of medications which were taken on discharge. The 2 test was used to
6
ACCEPTED MANUSCRIPT compare categorical variables and the t-test used to investigate the relationship between continuous variables between the 2 groups. Cox proportional hazard modeling was
PT
applied to all-cause and cardiovascular mortality. Variables significant on univariate
RI
analysis (p
