Patients with acute decompensated heart failure in an area with a super-aging society; A single- center, retrospective cohort study

Patients with acute decompensated heart failure in an area with a super-aging society; A single- center, retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patients with acute decompensated heart failure in an area with a super-aging society; A single- center, retrospective cohort study Junya Tanabe, Hiroyuki Sasaki, Kouichi Okazaki, Atsuyoshi Maeda, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4115717/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In recent years, the population of very elderly heart failure (HF) patients has been rising, but there are few reports on their characteristics, treatment, and prognosis. Methods This study included patients aged 18 years or older with acute HF admitted to a single hospital between April 1, 2016, and March 31, 2021. Patients were classified into three groups according to their echocardiographic left ventricular ejection fraction (LVEF): HF with reduced LVEF (LVEF < 40%: HFrEF), HF with mildly reduced LVEF (LVEF between 40% and 49%: HFmrEF), and HF with preserved LVEF (LVEF ≥ 50%: HFpEF). Results Of 524 admitted patients, 437 were discharged, including 124 with HFrEF, 62 with HFmrEF, and 251 with HFpEF. The median age was 86 years, and patients with HFmrEF and HFpEF were older than those with HFrEF. Overall, the in-hospital mortality rate was 14.1%, the 1-year composite event rate of cardiac death and heart failure readmission was 37.7%, and the 1-year all-cause death rate was 19.7%. In particular, the composite event rate was higher in patients with HFrEF than in those with HFpEF (44.0% vs. 32.8%, P = 0.03). Conclusions The high incidence of in-hospital mortality, composite events, and all-cause mortality in this very elderly population warrants prospective consideration of appropriate treatment choices and goal setting for these patients. Heart failure Ejection fraction Old age Mortality Readmission Figures Figure 1 Figure 2 Background Japan has a fairly long life expectancy, with an average of 82.6 years for men and 87.7 years for women, and the average aging rate (percentage of the population over 65 years old) is 28.7%, which high by global standards (as of 2020). With the aging population, the number of patients with heart failure (HF) patients is increasing. However, current data on HF treatment and prognosis are mostly based on an average age of 65–70 years, with limited evidence for patients over 75 years of age. The management of very elderly HF patients with HF is beyond the scope of current HF practice guidelines and requires individualized care [ 1 – 3 ]. This study investigated the background, medications, and outcomes of patients with HF in this very aged population. Methods Study design This single-center, retrospective, observational study was conducted among patients aged 18 years or older admitted to Saiseikai Gotsu General Hospital with a diagnosis of acute decompensated heart failure (ADHF) between April 1, 2016, and March 31, 2021. The requirement for informed consent was waived because this study used an opt-out system. The Declaration of Helsinki and ethical standards of the responsible committee on human experimentation were followed. This study was approved by the Institutional Ethics Committee of Saiseikai Gotsu General Hospital (No. R3-2). Gotsu City, Shimane Prefecture, Japan has a population of approximately 23,000 and an even higher aging rate of 39.2% compared to the rest of Japan. Saiseikai Gotsu General Hospital is the only general hospital in Gotsu City, and almost all patients with acute HF in this area visit this hospital. Study endpoints The primary endpoint of this study was the comparison of the cumulative incidence that composite of cardiovascular death and readmission owing to worsening HF within 1-year of discharge among the three LVEF groups. The secondary endpoint was the comparison of cumulative incidence of all-cause death within 1-year of discharge among three LVEF groups. Cardiovascular death was defined as death due to HF, myocardial infarction, cardiogenic shock, sudden cardiac death (non-traumatic, unexpected death occurring within 24 hours after last having been seen alive if death is not witnessed), or other cardiac causes. Worsening HF was defined on the basis of symptoms and signs, such as dyspnea, rales, and edema, and need for treatment with diuretics, vasodilators, inotropic drugs. Information on post-discharge outcomes was also collected from electronic medical records. Diagnostic criteria ADHF was defined according to the Framingham Acute Heart failure criteria [ 4 ]. Patients with acute coronary syndrome who met the definition of ADHF were also included. Patient medical information such as age, sex, body mass index (BMI), comorbidities, laboratory data at admission, length of hospital stay, and prescriptions at discharge were collected from the electronic medical records. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula, and chronic kidney disease (CKD) was defined as an eGFR of < 60 mL/min/1.73m 2 . Chronic respiratory disease was defined as a history of chronic obstructive pulmonary disease, asthma, interstitial pneumonia, or pulmonary tuberculosis. Patients were classified into three groups according to the Japanese Circulation Society guidelines [ 5 ] using the left ventricular ejection fraction (LVEF) on echocardiography performed after admission: HF with reduced LVEF (HFrEF) for LVEF < 40%, HF with mildly reduced LVEF (HFmrEF) for LVEF between 40% and 49%, and HF with preserved LVEF (HFpEF) for LVEF ≥ 50%. The post-discharge prognosis was monitored until March 31, 2022, allowing a follow-up of the outcomes at 12 months. Post-discharge outcome analysis was performed excluding patients who died during hospitalization, and the time was calculated from the date of discharge. Statistical analysis Categorical data are reported as percentages and continuous variables were reported as medians and interquartile ranges (IQR). The clinical characteristics of HFrEF, HFmrEF, and HFpEF were tested using the Kruskal-Wallis test and pairwise comparisons were performed using the Mann-Whitney U test. Differences between LVEF groups were tested using the log-rank test. Kaplan - Meier curves were plotted for all-cause death and for combined cardiac death and HF readmission. Univariate Cox proportional hazards analysis and multivariate Cox proportional hazards analyses were performed to examine the association between clinical characteristics, the composite endpoints including cardiac death and HF readmission, and all-cause mortality in each LVEF stratum. All P values were two-sided, and P values less than or equal to 0.05 were considered statistically significant. All statistical analyses were performed using EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), a graphical user interface of R (The R Foundation for Statistical Computing, Vienna, Austria). More precisely, it is a modified version of R commander designed to add statistical functions frequently used in biostatistics [ 6 ]. Results Patient population and demographics A total of 524 patients diagnosed with ADHF were admitted to Saiseikai Gotsu General Hospital between April 1, 2016, and March 31, 2021, with a diagnosis of ADHF. 15 of these patients were excluded because their echocardiographic LVEF data were unavailable. 504 patients were classified into three groups according to the echocardiography performed during hospitalization: HFrEF, HFmrEF, and HFpEF. 72 of these patients died in the hospital. A total of 437 patients were discharged from the hospital: 124 (28.4%) with HFrEF, 62 (14.2%) with HFmrEF, and 251 (57.4%) with HfpEF (Fig. 1 ). Table 1 summarizes the patient information. The overall median age was very old, 86 years (IQR 78–92). Patients with HFmrEF and HFpEF were older than those with HFrEF and had a higher proportion of women. Body mass index (BMI) was not recorded in five of the patients, but there were no significant differences in LVEF. The incidence of diabetes was higher in patients with HFrEF than in patients with HFpEF; however, other comorbidities (coronary artery disease, atrial fibrillation, hypertension, lipid abnormalities, CKD, and chronic lung disease) did not differ significantly according to LVEF. Brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) levels were recorded separately by patients: 146 patients had BNP, 328 patients had NT-proBNP, and 35 patients had no record. BNPlevels was higher in HFrEF than in HFpEF, and NT-proBNP level was higher in response to lower LVEF. The median length of hospital stay was 25 days (IQR 15–44), in patients with HFrEF and HFmrEF having longer stays compared to patients with HFpEF. The overall in-hospital mortality rate was 14.1% (n = 72), which did not differ according to LVEF. Table 1 Baseline clinical characteristics, length of hospital stay, in-hospital mortality, and medication at discharge in HFrEF, HFmrEF, and HFpEF. All Missing value HFrEF HFmrEF HFpEF P-value Pairwise comparisons (N = 509) (N = 143) (N = 75) (N = 291) Patient characteristics Age, years 86 (78–92) 0 83(74-88.5) 88(80-92.5) 87(80–92) < 0.001 R < M, P Female sex 276 (54.2%) 0 58(40.6%) 43(57.3%) 175(60.1%) < 0.001 R < M, P BMI, kg/m 2 21.8 (19.6–24.3) 5 (1.0%) 22.0(18.8–24.7) 22.0(20.1–25.0) 21.8(19.7–24.0) 0.67 R, M, P Medical history 0 Coronary artery disease 182 (35.8%) 58(40.6%) 33(44%) 91(31.3%) 0.045 R, M, P Atrial fibrillation 192 (37.7%) 58(40.6%) 31(41.3%) 103(35.4%) 0.45 R, M, P Hypertension 376 (73.9%) 101(70.6%) 53(70.7%) 222(76.3%) 0.36 R, M, P Diabetes mellitus 146 (28.7%) 50(35.0%) 27(36%) 69(23.7%) 0.02 R > P Dyslipidemia 225 (44.2%) 63(44.1%) 40(53.3%) 122(41.9%) 0.21 R, M, P Chronic Kidney Disease 391 (76.8%) 109(76.2%) 58(77.3%) 224(77.0%) 0.98 R, M, P Hemodialysis 7 (1.4%) 2(1.4%) 0(0%) 5(1.7%) 0.52 R, M, P Chronic respiratory disease 108 (21.2%) 26(18.2%) 16(21.3%) 66(22.7%) 0.56 R, M, P Laboratory data at admission BNP, pg/mL(N = 146) 538 (279–884) 35 (6.9%) 700(471–1215) 536(400–1350) 380(176–798) P NT-proBNP, pg/mL(N = 328) 4278 (1676–9326) 0 8087(4291–16347) 5212(2286–12623) 2596(1072–6808) M > P Cr, mg/dL 1.09 (0.80–1.56) 0 1.14(0.83–1.61) 1.07(0.80–1.44) 1.09(0.80–1.56) 0.48 R, M, P eGFR, mL/min/BSA 42.7 (30.0-57.7) 0 42.6(29.1–58.9) 44.2(31.9–59.5) 42.2(30.2–57.1) 0.656 R, M, P LVEF, % 53 (36–64) 0 30(24–35) 44(41–47) 62(56–70) Length of hospital stay, days 25 (15–44) 0 26(17.5–44) 31(18–48) 22(13–40) 0.01 R, M > P In-hospital mortality 72 (14.1%) 19(13.3%) 13(17.3%) 40(13.7%) 0.93 R, M, P Medication at discharge N = 437 0 N = 124 N = 62 N = 251 Number of agents 8 (6–10) 7(6–10) 9(7–10) 7(6–9) 0.051 M > P ACEI/ARB 231 (52.9%) 78(62.9%) 30(48.4%) 123(49.0%) 0.03 R > P BB 234 (53.5%) 91(73.4%) 39(62.9%) 104(41.4%) P MRA 105 (24.0%) 37(29.8%) 18(29.0%) 50(19.9%) 0.08 R, M, P SGLT2I 15 (3.4%) 9(7.3%) 4(6.5%) 2(0.8%) 0.002 R, M > P Tolvaptan 79 (18.1%) 34(27.4%) 11(17.7%) 34(13.5%) 0.005 R > P Loop diuretics 314 (71.9%) 106(85.4%) 48(77.4%) 160(63.7%) P Ca channel blocker 148 (33.9%) 27(21.8%) 18(29.0%) 103(41.0%) 0.001 R < P Anti-coagulation 152 (34.8%) 50(40.3%) 23(37.1%) 79(31.5%) 0.24 R, M, P Warfarin 62 (14.2%) 18(14.5%) 11(17.7%) 33(13.1%) 0.72 R, M, P DOAC 90 (20.6%) 32(25.8%) 12(19.4%) 46(18.3%) 0.22 R, M, P Anti-platelet 172 (39.3%) 49(39.5%) 28(45.2%) 95(37.8%) 0.74 R, M, P Anti-diabetic 85 (19.5%) 29(23.4%) 19(30.6%) 37(14.7%) 0.01 M > P Statin 184 (42.1%) 52(41.9%) 31(50.0%) 101(40.2%) 0.57 R, M, P ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers; BMI, body mass index; BNP, brain natriuretic peptide; Cr, creatinine; DOAC, direct oral anticoagulant; eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction; MRA, mineralocorticoid receptor antagonists; NT-proBNP, N-terminal proBNP; SGLT2I, sodium-glucose cotransporter 2 inhibitors. R, HFrEF; M, HFmrEF; P, HFpEF. Note: Values are expressed as median (interquartile range; 25 th to 75 th percentile value) for continuous variables and as percentages for categorical variables. Regarding prescriptions at discharge, there was a median of 8 medications (IQR 6–10) overall and no significant difference in LVEF. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) were prescribed more frequently in the HFrEF group than in the HFpEF group, whereas beta-blockers (BB) and sodium-glucose cotransporter 2 inhibitors (SGLT2I) were prescribed more frequently in the HFrEF and HFmrEF groups than in the HFpEF group. Tolvaptan and loop diuretics had higher prescription rates in the HFrEF group than in the HFpEF group; however, for Ca channel antagonists, the prescription rates were higher in the HFpEF group than in the HFrEF group. The prescription rates of hypoglycemic drugs, including SGLT2I, were higher in patients with HFmrEF. There were no significant differences in LVEF between mineralocorticoid receptor antagonists (MRA), antithrombotics (anticoagulants and antiplatelets), and statins. Post-discharge cause-specific outcomes The median observation period after discharge was 558 days (IQR 205–1087). The incidence of composite events (cardiac death and HF readmission) was significantly higher in the HFrEF group than that in the HFpEF group. The 1-year composite event rates were 44.0% (95% CI: 35.2–54.0) for HFrEF, 44.3% (95% CI: 32.1–58.7) for HFmrEF, and 32.8% (95% CI: 26.8–39.7) for HFpEF. The incidence of all-cause mortality did not differ significantly among the HFrEF, HFmrEF, and HFpEF groups (Fig. 2 , Table 2 ). Table 2 1-year event rate for composite outcomes and all-cause death in overall in patients with HFrEF, HFmrEF, and HFpEF. 1-year event rate, % (95%CI) All HFrEF HFmrEF HFpEF P-value Pairwise comparisons Composite endpoint (Cardiac death + HF readmission) 37.70% 44.00% 44.30% 32.80% 0.03 R > P (33.0–43.0) (35.2–54.0) (32.1–58.7) (26.8–39.7) All-cause death 19.70% 19.50% 18.80% 20.00% 0.89 R, M, P (16.0-24.2) (13.1–28.3) (10.5–32.2) (15.2–26.2) R, HFrEF; M, HFmrEF; P, HFpEF. Predictors of post-discharge outcomes HFrEF showed no significant association with the hazard ratio for 1-year composite outcomes in the univariate analysis of each variable; however, in the multivariate analysis, there was a significant association with age. For HFmrEF, both the univariate and multivariate analyses revealed significant associations with age. HFpEF was significantly associated with age, coronary artery disease, atrial fibrillation, chronic lung disease, ACEI/ARB, BB, and MRA, whereas multivariate analysis showed significant associations only with age (Table 3 , 4 ). In HFrEF, univariate analysis of the hazard ratios for 1-year all-cause death showed significant associations with age and ACEI/ARB use; however, multivariate analysis showed significant associations only with age. In HFmrEF, univariate analysis showed significant associations only with age; whereas multivariate analysis showed significant associations with age, coronary artery disease, CKD, chronic lung disease, and ACEI/ARB administration. HFpEF was significantly associated with age, coronary artery disease, hypertension, chronic lung disease, and ACEI/ARB use. However, multivariate analysis showed significant associations between age and chronic lung disease (Table 5 , 6 ). Table 3 Predictors for 1-year composite outcomes in patients with HFrEF, HFmrEF, and HFpEF (univariate analysis). HFrEF HFmrEF HFpEF HR (95%CI) P-value HR (95%CI) P-value HR (95%CI) P-value Age 1.02 (1.00-1.05) 0.07 1.10 (1.05–1.16) < 0.001 1.06 (1.03–1.09) < 0.001 Coronary artery disease 1.09 (0.66–1.81) 0.73 0.62 (0.30–1.28) 0.2 0.43 (0.26–0.71) < 0.001 Atrial fibrillation 1.17 (0.71–1.93) 0.54 1.46 (0.71–2.98) 0.31 1.60 (1.05–2.43) 0.03 Hypertension 0.85 (0.50–1.45) 0.56 1.42 (0.61–3.33) 0.42 0.70 (0.44–1.11) 0.13 Diabetes mellitus 0.80 (0.48–1.35) 0.41 1.98 (0.96–4.05) 0.06 0.99 (0.62–1.59) 0.98 Chronic kidney disease 1.06 (0.57–1.95) 0.86 1.05 (0.45–2.46) 0.91 1.68 (0.99–2.84) 0.054 Chronic respiratory disease 1.01 (0.54–1.90) 0.97 2.13 (0.90–5.05) 0.09 1.69 (1.06–2.70) 0.03 ACEI/ARB 1.27 (0.75–2.16) 0.38 0.83 (0.40–1.70) 0.61 0.50 (0.33–0.75) 0.001 BB 1.03 (0.60–1.78) 0.91 0.55 (0.27–1.15) 0.11 1.65 (1.09–2.48) 0.02 MRA 0.74 (0.42–1.29) 0.29 1.39 (0.61–3.15) 0.43 1.68 (1.03–2.75) 0.04 ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers; MRA, mineralocorticoid receptor antagonists. Table 4 Predictors for 1-year composite outcomes in patients with HFrEF, HFmrEF, and HFpEF (multivariate analysis). HFrEF HFmrEF HFpEF HR (95%CI) P-value HR (95%CI) P-value HR (95%CI) P-value Age 1.03 (1.01–1.06) 0.02 1.13 (1.06–1.21) < 0.001 1.04 (1.02–1.07) 0.003 Coronary artery disease 1.46 (0.82–2.58) 0.2 1.58 (0.55–4.54) 0.39 0.71 (0.41–1.23) 0.22 Atrial fibrillation 1.27 (0.72–2.24) 0.41 1.44 (0.56–3.71) 0.46 1.20 (0.73–1.96) 0.48 Hypertension 0.81 (0.45–1.46) 0.48 1.32 (0.46–3.81) 0.61 1.15 (0.66–1.99) 0.63 Diabetes mellitus 0.81 (0.46–1.43) 0.46 1.67 (0.70–3.99) 0.25 1.14 (0.70–1.88) 0.59 Chronic kidney disease 1.02 (0.54–1.93) 0.95 0.39 (0.14–1.04) 0.06 1.34 (0.78–2.30) 0.29 Chronic respiratory disease 0.90 (0.47–1.73) 0.76 2.32 (0.89–6.08) 0.09 1.44 (0.88–2.36) 0.15 ACEI/ARB 1.72 (0.94–3.13) 0.08 0.73 (0.27–1.97) 0.54 0.63 (0.39–1.04) 0.07 BB 1.08 (0.59–1.96) 0.8 0.60 (0.27–1.36) 0.22 1.56 (0.99–2.47) 0.06 MRA 0.64 (0.35–1.15) 0.13 1.16 (0.42–3.15) 0.78 1.24 (0.75–2.06) 0.4 ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers; MRA, mineralocorticoid receptor antagonists. Table 5 Predictors for 1-year all-cause death in patients with HFrEF, HFmrEF, and HFpEF (univariate analysis). HFrEF HFmrEF HFpEF HR (95%CI) P-value HR (95%CI) P-value HR (95%CI) P-value Age 1.06 (1.02–1.09) 0.001 1.06 (1.01–1.11) 0.01 1.10 (1.06–1.14) < 0.001 Coronary artery disease 0.75 (0.41–1.39) 0.37 0.96 (0.41–2.23) 0.92 0.37 (0.21–0.64) < 0.001 Atrial fibrillation 0.86 (0.47–1.56) 0.61 1.22 (0.52–2.83) 0.65 1.33 (0.83–2.11) 0.23 Hypertension 0.59 (0.32–1.07) 0.08 0.78 (0.33–1.87) 0.58 0.50 (0.31–0.79) 0.003 Diabetes mellitus 1.07 (0.58–1.95) 0.83 1.44 (0.62–3.33) 0.39 0.76 (0.44–1.32) 0.33 Chronic kidney disease 1.21 (0.58–2.52) 0.61 0.62 (0.25–1.52) 0.29 1.03 (0.62–1.73) 0.9 Chronic respiratory disease 0.78 (0.35–1.75) 0.54 0.21 (0.03–1.58) 0.13 2.10 (1.30–3.38) 0.002 ACEI/ARB 0.45 (0.25–0.82) 0.009 0.46 (0.19–1.08) 0.08 0.55 (0.35–0.86) 0.008 BB 0.58 (0.31–1.06) 0.08 0.54 (0.23–1.25) 0.15 1.33 (0.84–2.08) 0.22 MRA 0.75 (0.38–1.49) 0.41 1.48 (0.57–3.82) 0.42 1.67 (0.98–2.84) 0.06 ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers; MRA, mineralocorticoid receptor antagonists. Table 6 Predictors for 1-year all-cause death in patients with HFrEF, HFmrEF, and HFpEF (multivariate analysis). HFrEF HFmrEF HFpEF HR (95%CI) P-value HR (95%CI) P-value HR (95%CI) P-value Age 1.06 (1.02–1.09) 0.004 1.15 (1.07–1.23) < 0.001 1.08 (1.05–1.12) < 0.001 Coronary artery disease 0.71 (0.36–1.41) 0.32 6.46 (1.44–29.1) 0.02 0.58 (0.31–1.09) 0.09 Atrial fibrillation 0.88 (0.41–1.86) 0.73 0.91 (0.32–2.61) 0.86 0.82 (0.48–1.39) 0.47 Hypertension 0.71 (0.35–1.42) 0.33 1.94 (0.61–6.13) 0.26 0.73 (0.41–1.28) 0.27 Diabetes mellitus 1.50 (0.74–3.03) 0.26 1.28 (0.46–3.56) 0.63 1.12 (0.62–2.02) 0.7 Chronic kidney disease 0.88 (0.39–1.98) 0.76 0.09 (0.02–0.32) < 0.001 0.85 (0.49–1.45) 0.54 Chronic respiratory disease 0.53 (0.23–1.27) 0.16 0.07 (0.01–0.59) 0.01 1.89 (1.15–3.11) 0.01 ACEI/ARB 0.73 (0.37–1.46) 0.37 0.21 (0.05–0.85) 0.03 0.94 (0.56–1.57) 0.81 BB 0.71 (0.36–1.41) 0.33 0.42 (0.14–1.24) 0.12 1.52 (0.91–2.52) 0.11 MRA 0.84 (0.41–1.73) 0.63 1.44 (0.43–4.77) 0.55 1.30 (0.74–2.27) 0.36 ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers; MRA, mineralocorticoid receptor antagonists. Discussion This study investigated the clinical characteristics, medications, and outcomes of HF patients with HF from a very elderly population. While previous clinical studies of patients with ADHF have reported a mean age range of 71–78 years, the median age of the patients in this study was 86 years, and many of these patients had a life expectancy longer than the average. Many patients were not included in the previous study, and studies are needed to collect and organize data on these patients in the future. Characteristics of HF patients in the super-aging society The proportion of patients with HFpEF in this study was high (57.2%). Even within this age range, the patients were older and had a higher proportion of women than those with HFrEF. Previous clinical studies have also shown that patients with HFpEF tends to be older and more likely to be female, suggesting that the proportion of patients with HFpEF is increasing in older populations [ 7 – 9 ]. In contrast, in previous studies, patients with HFrEF tended to have more coronary artery disease complications than those with HFpEF, and patients with HFpEF tended to have more atrial fibrillation complications than those with HFrEF; however, no significant differences in complication rates were found in this study [ 7 – 9 ]. BNP and NT-proBNP levels were similar to those reported in previous studies and tended to be higher in patients with lower LVEF. Pharmacotherapy of HF patients in a super-aging society Although the JCS guidelines recommend ACEI/ARB, BB, and MRA to improve the prognosis of HFrEF, the induction rates of ACEI/ARB, BB, and MRA tended to be low for HFrEF in this study (62.9%, 73.4%, and 29.8%, respectively). This was not sufficient compared with previous clinical studies, and age and renal function could have affected the results [ 10 – 12 ]. In patients with HFrEF, the incidence of composite events did not differ between those treated with and without ACEI/ARB, BB, or MRA. Previous reports have shown that guideline-based medical treatment (using both ACEI/ARB and BB: GBMT) for patients with HFrEF aged < 80 years of age reduced the incidence of composite events; the present study results were similar, as there was no significant difference in the incidence of composite events between patients with HFrEF with and without GBMT for patients with HFrEF aged > 80 years of age [ 2 ]. In contrast, in patients with HFpEF, the incidence of composite events was lower in those taking ACEI/ARB and higher in those taking BB and MRA in univariate analysis. Previous studies examining outcomes in patients with HFpEF with or without ACEI/ARB administration [ 13 ], found no significant differences in CD and HF readmission but tended to have better outcomes. Another study reported no significant differences in cardiac death or HF readmission with or without BB and MRA administration [ 14 , 15 ]. However, in the multivariate analysis, significant differences in the presence or absence of these drugs disappeared, suggesting that age and the severity of the patient’s background may have had an effect. In terms of the incidence of all-cause death, the presence or absence of ACEI/ARB administration was significantly different in patients with HFmrEF in the multivariate analysis; however, the hazard ratio was lower in patients with CKD or chronic lung disease, which is different from the results of previous Japanese studies, suggesting that the very small number of patients (n = 62) involved in the study was the reason for the extreme results [ 16 ]. Outcomes of HF patients in a super-aging society The in-hospital mortality rate in previous studies was 6.4-8% in Japanese cohort [ 5 , 17 ] and 2.1–3.4% in a European cohort [ 18 ], and 3.1% in an American cohort [ 9 ], whereas in this study, it was much higher at 14.1%. This was expected because the study included very elderly patients. The 1-year overall rate of composite events was 37.7%, which was higher than the 23.7% reported previously [ 19 ] and was significantly higher for HFrEF than for HFpEF. Differences in LVEF varied, with some reports showing that HFpEF was as poor as HFrEF, whereas others showed significantly worse results for HFrEF, as observed in the present study. The 1-year incidence of all-cause death varied from 7.3–21.8% in previous Japanese reports [ 5 , 20 ], but tended to be higher in this study (19.7% overall). The trend toward worse outcomes (composite events and all-cause death) in the present study was likely due, in large part, to age. In contrast, the event rate for composite events was higher in the HFpEF group than in the HFrEF group, despite the older age of the patients. This may be related to the lower rate of introduction of cardioprotective agents such as ACEI/ARB, BB, and MRA. The efficacy of these agents in very elderly patients with HF, who have not been included in large clinical studies, needs to be prospectively investigated. Limitations Our study has several limitations. First, we collected the LVEF data during index hospitalization; however, there was no information on the exact timing of echocardiography during hospitalization, which may have been temporarily affected by co-existing conditions. The presented analysis was based on a single LVEF assessment during hospitalization and was not repeated during follow-up; therefore, we did not observe a change in LVEF. Second, treatment during hospitalization was at the discretion of the attending physician, and the prescriptions recorded were those at the time of discharge and may have been originally taken or subsequently discontinued, increased, or added. Third, during the period covered in this study, the new HF drugs angiotensin receptor neprilysin inhibitors (ARNI) and SGLT2I had not yet been indicated for the treatment of HF; therefore, the new HF drugs were not introduced, and their introduction rates were very low. Fourth, while some studies have reported worse prognoses for frail patients about HF treatment and frailty, others have suggested that patients with frailty may benefit more from HF medications [ 21 ]. Although this study included a very elderly population, which would be expected to have more frail patients, we were unable to collect sufficient measures of frailty and thus could not address this relationship. Fifth, HF with supernormal EF has been reported to have a poor prognosis, and care should be taken in interpreting the results of this study, since the prognosis may vary depending on whether the patient is classified as supernormal or not, even among patients classified as HFpEF [ 22 ]. Sixth, nursing home use may influence the event rate of HF readmission, and, information on social factors, such as information on caregiving, is needed [ 23 ]. The possibility that potential confounding factors may influence prognosis cannot be ruled out, so caution must be exercised in drawing the conclusion that HFpEF has a good prognosis based on the results of this study. Seventh, to examine the characteristics of HF patients in this region, we included patients with acute coronary syndrome if they met the criteria, but these patients should have been excluded to more accurately assess the association between EF and outcome. Finally, the number of patients analyzed was too small to draw a definitive conclusion, and this was an observational study conducted at a single institution. Conclusions This study examined the clinical characteristics, prescriptions, and outcomes of patients with HF in a super-aging society. The median age of the patients in this study was 86 years, which makes this one of the few reports to present data on patients not included in previous evidence. The high incidence of in-hospital mortality, composite events, and all-cause mortality in this very elderly population warrants prospective consideration of appropriate treatment choices and goal setting for these patients. Abbreviations ACEI angiotensin-converting enzyme inhibitors ADHF acute decompensated heart failure ARB angiotensin receptor blockers BB beta-blockers BMI body mass index BNP brain natriuretic peptide CKD chronic kidney disease eGFR estimated glomerular filtration rate HF heart failure HFrEF heart failure with reduced ejection fraction HFmrEF heart failure with mildly reduced ejection fraction HFpEF heart failure with preserved ejection fraction IQR interquartile ranges LVEF left ventricular ejection fraction MRA mineralocorticoid receptor antagonists NT-proBNP N-terminal proBNP SGLT2I sodium-glucose cotransporter 2 inhibitors Declarations Author contributions JT, AE, YN and KT conceptualized the study design. JT, HS, KO and AM collected data. JT analyzed data and prepared the original draft of the manuscript, the tables and figures. All authors have reviewed and agreed to the final manuscript. Funding None. Availability of data and materials All data relevant to the study are included in the article. Data sharing is not applicable in this study due to the restrictions of institutional review boards. Ethical approval and consent to participate This study was approved by the institutional ethics committee of Saiseikai Gotsu General Hospital and conformed to the Declaration of Helsinki. The requirement for informed consent was waived by ethics committee of Saiseikai Gotsu General Hospital based on the study’s retrospective analysis of patient data. Consent for publication Not applicable Competing interests All authors declare no competing interests associated with this manuscript. 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Bone Marrow Transplant. 2013;48:452-8 Takei M, Kohsaka S, Shiraishi Y, Goda A, Nagatomo Y, Mizuno A, Suzino Y, Kohno T, Fukuda F, Yoshikawa T. Heart failure with midrange ejection fraction in patients admitted for acute decompensation: a report from the Japanese multicenter registry. J Cardiac Fail. 2019;25:666-73. Chen Y, Voors AA, Jaarsma T, Lang CC, Sama IE, Akkerhuis KM, Boersma E, Hillege HL, Postmus D. A heart failure phenotype stratified model for predicting 1-year mortality in patients admitted with acute heart failure: results from an individual participant data meta-analysis of four prospective European cohorts. BMC Med. 2021;19:21. Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF, Butler J, Yancy CW, Fonarow GC. Precipitating clinical factors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction. JACC Heart Fail. 2016;4:464-72. Kase M, Fujiki S, Kashimura T, Okura Y, Kodera K, Watanabe H, Takahashi K, Bannai S, Hatano T, Tanaka T, Kitamura N, Minamino T, Inomata T. Relationship between medical therapy, long-term care insurance, and comorbidity in elderly patients with heart failure with systolic dysfunction. Circ J. 2023;87:1130-7. Savarese G, Bodegard J, Norhammar A, Sartipy P, Thursson M, Cowie MR, Fonarow GC, Vaduganathan M, Coats AJS. Heart failure drug titration, discontinuation, mortality and heart failure hospitalization risk: a multinational observational study (US, UK and Sweden). Eur J Heart Fail. 2021;23:1499-1511. Bozkurt B. Reasons for lack of improvement in treatment with evidence-based therapies in heart failure. J Am Coll Cardiol. 2019;73:2384-7. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJV, Michelson EL, Olofsson B, Ostergren J. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet. 2003;362:777-81. Yamamoto K, Origasa H, Hori M, J-DHF Investigators. Effects of carvedilol on heart failure with preserved ejection fraction: the Japanese Diastolic Heart Failure Study (J-DHF). Eur J Heart Fail. 2013;15:110-8. Ferreira JP, Rossello X, Eschalier R, Mcmurray JJV, Pocock S, Girerd N, Rossignol P, Pitt B, Zannad F. MRAs in elderly HF patients: individual patient-data meta-analysis of RALES, EMPHASIS-HF, and TOPCAT. JACC Heart Fail. 2019;7:1012-21. Tsuji K, Sakata Y, Nochioka K, Miura M, Yamauchi T, Onose T, Abe R, Oikawa T, Kasahara S, Sato M, Shiroto T, Takahashi J, Miyata S, Shimokawa H. CHART-2 InvestigatorsCharacterization of heart failure patients with mid-range left ventricular ejection fraction-a report from the CHART-2 Study. Eur J Heart Fail. 2017;19:1258-69. Shiga T, Suzuki A, Haruta S, Mori F, Ota Y, Yagi M, Oka T, Tanaka H, Murasaki S, Yamauchi T, Katoh J, Hattori H, Kikuchi N, Watanabe E, Yamada Y, Haruki S, Kogure T, Suzuki T, Uetsuka Y, Hagiwara N; HIJ-HF II Investigators. Clinical characteristics of hospitalized heart failure patients with preserved, mid-range, and reduced ejection fractions in Japan. ESC Heart Fail. 2019;6:475-86. Kaplon-Cieskicka A, Benson L, Chioncel O, Crespo-Leiro, Coats AJS, Anker SD, Filippatos G, Ruschitzka F, Hage C, Drożdż J, Seferovic P, Rosano GMC, Piepoli M, Mebazaa A, McDonagh T, Lainscak M, Savarese G, Ferrari R, Maggioni AP, Lund LH; on behalf of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the ESC Heart Failure Long-Term Registry Investigators. A comprehensive characterization of acute heart failure with preserved versus mildly reduced versus reduced ejection fraction - insights from the ESC-HFA EORP Heart Failure Long-Term Registry. Eur J Heart Fail. 2022;24:335-50. Sato Y, Yoshihisa A, Ide T, Tohyama T, Enzan N, Matsushima S, Tsutsui H, Takeishi Y. Regional variation in the clinical practice and prognosis in patients with heart failure with reduced ejection fraction in Japan - A report from the Japanese Registry of Acute Decompensated Heart Failure (JROADHF). Circ J. 2023;87:1380-91. Tsuchihashi-Makaya M, Hamaguchi S, Kinugawa S, Yokota T, Goto D, Yokoshiki H, Kato N, Takeshita A, Tsutsui H; JCARE-CARD Investigators. Characteristics and outcomes of hospitalized patients with heart failure and reduced vs preserved ejection fraction. Report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J. 2009;73:1893-900. Sunaga A, Hikoso S, Tamaki S, Seo M. Yano M, Hayashi T, Nakagawa A, Nakagawa Y, Kurakami H, Yamada T, Kitamura T, Sato T, Oeun B, Kida H, Sotomi Y, Dohi T, Okada K, Mizuno H, Nakatani D, Yamada T, Yasumura Y, Sakata Y and OCVC-Heart Failure Investigator. Association between prognosis and the use of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers in frail patients with heart failure with preserved ejection fraction. ESC Heart Fail. 2022;9:1801-11. Ohte N, Kikuchi S, Iwahashi N, Kinugasa Y, Dohi K, Takase H, Masai K, Inoue K, Okumura T, Hachiya K, Kitada S, Seo Y; EASY HFpEF Investigators. Unfavourable outcomes in patients with heart failure with higher preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging. 2023;24:293-300. Takabayashi K, Fujita R, Iwatsu K, Ikeda T, Morikami Y, Ichinohe T, Yamamoto T, Takenaka K, Okuda M, Nakajima O, Koito H, Terasaki Y, Kitamura T, Kitaguchi S, Nohara R. Impact of home- and community-based services in the long-term care insurance system on outcomes of patients with acute heart failure: Insights from the Kitakawachi Clinical Background and Outcome of Heart Failure Registry. Geriatr Gerontol Int. 2020;20:967-73. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4115717","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":284284910,"identity":"033a9e5b-ec55-485c-82c3-3486c4bcb018","order_by":0,"name":"Junya Tanabe","email":"","orcid":"","institution":"Shimane University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Junya","middleName":"","lastName":"Tanabe","suffix":""},{"id":284284911,"identity":"85fb4381-f8df-4ec7-8a35-91e18bc48ebb","order_by":1,"name":"Hiroyuki Sasaki","email":"","orcid":"","institution":"Saiseikai Gotsu General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hiroyuki","middleName":"","lastName":"Sasaki","suffix":""},{"id":284284912,"identity":"eba6f47f-0cd5-47ba-b5ef-0110efddafe1","order_by":2,"name":"Kouichi Okazaki","email":"","orcid":"","institution":"Shimane University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kouichi","middleName":"","lastName":"Okazaki","suffix":""},{"id":284284913,"identity":"914b211e-a3c5-4eb3-b811-869159126cc9","order_by":3,"name":"Atsuyoshi Maeda","email":"","orcid":"","institution":"Saiseikai Gotsu General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Atsuyoshi","middleName":"","lastName":"Maeda","suffix":""},{"id":284284914,"identity":"38466c82-a1d2-45b1-9917-25b66e537811","order_by":4,"name":"Akihiro Endo","email":"","orcid":"","institution":"Shimane University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Akihiro","middleName":"","lastName":"Endo","suffix":""},{"id":284284915,"identity":"0355f1ec-bf0c-4cfd-918e-2d822aab8b18","order_by":5,"name":"Yoshio Nakazawa","email":"","orcid":"","institution":"Saiseikai Gotsu General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yoshio","middleName":"","lastName":"Nakazawa","suffix":""},{"id":284284916,"identity":"8a2bfb5e-4f3e-461f-ad3b-c5219ac4bb3e","order_by":6,"name":"Kazuaki Tanabe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYBACCQYGxgcMDMxAFmMDkjgPXi3MBiRrYZOAaCHWYZLtx59V3aiwZpCf3dy64ecOGwaDA8wPPzDI3MGpRZonIe12zpl0BoM7B9tu9p5JA2phM5Zg4HmGU4scQ8Kx27lthxkMJBLbbvC2Ha7fcIDBDOiXw7i18D9sK879d5hBfkZi282/bf+BtrB/w6tFWiKZjTm3AajgRmLbbd62A0AtPPhtkZzxjFk651g6jwFIi2xbMoPkYZ5iiQQ8fpE4n/7wc06NtZz8jPRnN9+22THwHW/f+OFjD+4QgwGkqAPGEUNizwGCWtDBD9K1jIJRMApGwbAFAHVyU8+VBHTuAAAAAElFTkSuQmCC","orcid":"","institution":"Shimane University Faculty of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Kazuaki","middleName":"","lastName":"Tanabe","suffix":""}],"badges":[],"createdAt":"2024-03-17 06:44:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4115717/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4115717/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53758532,"identity":"6aab83db-07d3-44f1-8b96-da253f341714","added_by":"auto","created_at":"2024-03-29 19:15:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":320230,"visible":true,"origin":"","legend":"\u003cp\u003eStudy outline.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4115717/v1/651fb2cfc705f2862ac1c390.png"},{"id":53758531,"identity":"04da0a50-f855-4715-99e6-ca45236eaa0e","added_by":"auto","created_at":"2024-03-29 19:15:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":188410,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier curves for survival analysis.\u003c/p\u003e\n\u003cp\u003e(A) Composite endpoints, including both cardiac death and heart failure readmission. (B) All-cause death. Black line, HFrEF; red line, HFmrEF; green line, HFpEF.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4115717/v1/63ac7ac81ce9d738b100056a.png"},{"id":59292639,"identity":"e3f30bae-7b67-4840-9436-61b2b77c4cc6","added_by":"auto","created_at":"2024-06-28 18:53:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1419820,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4115717/v1/6c8f51b0-67c0-4208-a891-7842d58fdec2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patients with acute decompensated heart failure in an area with a super-aging society; A single- center, retrospective cohort study","fulltext":[{"header":"Background","content":"\u003cp\u003eJapan has a fairly long life expectancy, with an average of 82.6 years for men and 87.7 years for women, and the average aging rate (percentage of the population over 65 years old) is 28.7%, which high by global standards (as of 2020). With the aging population, the number of patients with heart failure (HF) patients is increasing. However, current data on HF treatment and prognosis are mostly based on an average age of 65\u0026ndash;70 years, with limited evidence for patients over 75 years of age. The management of very elderly HF patients with HF is beyond the scope of current HF practice guidelines and requires individualized care [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This study investigated the background, medications, and outcomes of patients with HF in this very aged population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis single-center, retrospective, observational study was conducted among patients aged 18 years or older admitted to Saiseikai Gotsu General Hospital with a diagnosis of acute decompensated heart failure (ADHF) between April 1, 2016, and March 31, 2021. The requirement for informed consent was waived because this study used an opt-out system. The Declaration of Helsinki and ethical standards of the responsible committee on human experimentation were followed. This study was approved by the Institutional Ethics Committee of Saiseikai Gotsu General Hospital (No. R3-2). Gotsu City, Shimane Prefecture, Japan has a population of approximately 23,000 and an even higher aging rate of 39.2% compared to the rest of Japan. Saiseikai Gotsu General Hospital is the only general hospital in Gotsu City, and almost all patients with acute HF in this area visit this hospital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy endpoints\u003c/h2\u003e \u003cp\u003eThe primary endpoint of this study was the comparison of the cumulative incidence that composite of cardiovascular death and readmission owing to worsening HF within 1-year of discharge among the three LVEF groups. The secondary endpoint was the comparison of cumulative incidence of all-cause death within 1-year of discharge among three LVEF groups. Cardiovascular death was defined as death due to HF, myocardial infarction, cardiogenic shock, sudden cardiac death (non-traumatic, unexpected death occurring within 24 hours after last having been seen alive if death is not witnessed), or other cardiac causes. Worsening HF was defined on the basis of symptoms and signs, such as dyspnea, rales, and edema, and need for treatment with diuretics, vasodilators, inotropic drugs. Information on post-discharge outcomes was also collected from electronic medical records.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDiagnostic criteria\u003c/h2\u003e \u003cp\u003eADHF was defined according to the Framingham Acute Heart failure criteria [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Patients with acute coronary syndrome who met the definition of ADHF were also included. Patient medical information such as age, sex, body mass index (BMI), comorbidities, laboratory data at admission, length of hospital stay, and prescriptions at discharge were collected from the electronic medical records. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula, and chronic kidney disease (CKD) was defined as an eGFR of \u0026lt;\u0026thinsp;60 mL/min/1.73m\u003csup\u003e2\u003c/sup\u003e. Chronic respiratory disease was defined as a history of chronic obstructive pulmonary disease, asthma, interstitial pneumonia, or pulmonary tuberculosis.\u003c/p\u003e \u003cp\u003ePatients were classified into three groups according to the Japanese Circulation Society guidelines [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] using the left ventricular ejection fraction (LVEF) on echocardiography performed after admission: HF with reduced LVEF (HFrEF) for LVEF\u0026thinsp;\u0026lt;\u0026thinsp;40%, HF with mildly reduced LVEF (HFmrEF) for LVEF between 40% and 49%, and HF with preserved LVEF (HFpEF) for LVEF\u0026thinsp;\u0026ge;\u0026thinsp;50%. The post-discharge prognosis was monitored until March 31, 2022, allowing a follow-up of the outcomes at 12 months. Post-discharge outcome analysis was performed excluding patients who died during hospitalization, and the time was calculated from the date of discharge.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eCategorical data are reported as percentages and continuous variables were reported as medians and interquartile ranges (IQR). The clinical characteristics of HFrEF, HFmrEF, and HFpEF were tested using the Kruskal-Wallis test and pairwise comparisons were performed using the Mann-Whitney U test. Differences between LVEF groups were tested using the log-rank test. Kaplan - Meier curves were plotted for all-cause death and for combined cardiac death and HF readmission. Univariate Cox proportional hazards analysis and multivariate Cox proportional hazards analyses were performed to examine the association between clinical characteristics, the composite endpoints including cardiac death and HF readmission, and all-cause mortality in each LVEF stratum. All P values were two-sided, and P values less than or equal to 0.05 were considered statistically significant. All statistical analyses were performed using EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), a graphical user interface of R (The R Foundation for Statistical Computing, Vienna, Austria). More precisely, it is a modified version of R commander designed to add statistical functions frequently used in biostatistics [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003ePatient population and demographics\u003c/h2\u003e\n \u003cp\u003eA total of 524 patients diagnosed with ADHF were admitted to Saiseikai Gotsu General Hospital between April 1, 2016, and March 31, 2021, with a diagnosis of ADHF. 15 of these patients were excluded because their echocardiographic LVEF data were unavailable. 504 patients were classified into three groups according to the echocardiography performed during hospitalization: HFrEF, HFmrEF, and HFpEF. 72 of these patients died in the hospital. A total of 437 patients were discharged from the hospital: 124 (28.4%) with HFrEF, 62 (14.2%) with HFmrEF, and 251 (57.4%) with HfpEF (Fig.\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e). Table\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e summarizes the patient information. The overall median age was very old, 86 years (IQR 78\u0026ndash;92). Patients with HFmrEF and HFpEF were older than those with HFrEF and had a higher proportion of women. Body mass index (BMI) was not recorded in five of the patients, but there were no significant differences in LVEF. The incidence of diabetes was higher in patients with HFrEF than in patients with HFpEF; however, other comorbidities (coronary artery disease, atrial fibrillation, hypertension, lipid abnormalities, CKD, and chronic lung disease) did not differ significantly according to LVEF. Brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) levels were recorded separately by patients: 146 patients had BNP, 328 patients had NT-proBNP, and 35 patients had no record. BNPlevels was higher in HFrEF than in HFpEF, and NT-proBNP level was higher in response to lower LVEF. The median length of hospital stay was 25 days (IQR 15\u0026ndash;44), in patients with HFrEF and HFmrEF having longer stays compared to patients with HFpEF. The overall in-hospital mortality rate was 14.1% (n\u0026thinsp;=\u0026thinsp;72), which did not differ according to LVEF.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eBaseline clinical characteristics, length of hospital stay, in-hospital mortality, and medication at discharge in HFrEF, HFmrEF, and HFpEF.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMissing value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHFrEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHFmrEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHFpEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePairwise comparisons\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;509)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;143)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;291)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86 (78\u0026ndash;92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83(74-88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88(80-92.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87(80\u0026ndash;92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR\u0026thinsp;\u0026lt;\u0026thinsp;M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e276 (54.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58(40.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43(57.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e175(60.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR\u0026thinsp;\u0026lt;\u0026thinsp;M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.8 (19.6\u0026ndash;24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.0(18.8\u0026ndash;24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.0(20.1\u0026ndash;25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.8(19.7\u0026ndash;24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"9\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoronary artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e182 (35.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58(40.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33(44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91(31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtrial fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e192 (37.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58(40.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31(41.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103(35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e376 (73.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101(70.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53(70.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e222(76.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146 (28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50(35.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27(36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69(23.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDyslipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e225 (44.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63(44.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40(53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e122(41.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic Kidney Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e391 (76.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109(76.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58(77.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e224(77.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemodialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic respiratory disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108 (21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(21.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66(22.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaboratory data at admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBNP, pg/mL(N\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e538 (279\u0026ndash;884)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e700(471\u0026ndash;1215)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e536(400\u0026ndash;1350)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e380(176\u0026ndash;798)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNT-proBNP, pg/mL(N\u0026thinsp;=\u0026thinsp;328)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4278 (1676\u0026ndash;9326)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8087(4291\u0026ndash;16347)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5212(2286\u0026ndash;12623)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2596(1072\u0026ndash;6808)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR\u0026thinsp;\u0026gt;\u0026thinsp;M\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCr, mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.09 (0.80\u0026ndash;1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.14(0.83\u0026ndash;1.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07(0.80\u0026ndash;1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.09(0.80\u0026ndash;1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eeGFR, mL/min/BSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.7 (30.0-57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.6(29.1\u0026ndash;58.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.2(31.9\u0026ndash;59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.2(30.2\u0026ndash;57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLVEF, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (36\u0026ndash;64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30(24\u0026ndash;35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44(41\u0026ndash;47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62(56\u0026ndash;70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength of hospital stay, days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (15\u0026ndash;44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(17.5\u0026ndash;44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31(18\u0026ndash;48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(13\u0026ndash;40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn-hospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72 (14.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40(13.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedication at discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"15\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of agents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (6\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(6\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(7\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(6\u0026ndash;9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eACEI/ARB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e231 (52.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78(62.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30(48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123(49.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e234 (53.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91(73.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39(62.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104(41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMRA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37(29.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(29.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50(19.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSGLT2I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTolvaptan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79 (18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34(27.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34(13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLoop diuretics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e314 (71.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106(85.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48(77.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e160(63.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCa channel blocker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e148 (33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27(21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(29.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103(41.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR\u0026thinsp;\u0026lt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnti-coagulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e152 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50(40.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23(37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79(31.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWarfarin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33(13.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDOAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90 (20.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32(25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(19.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46(18.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnti-platelet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e172 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49(39.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28(45.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95(37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnti-diabetic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 (19.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29(23.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37(14.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e184 (42.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52(41.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31(50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101(40.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003eACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers; BMI, body mass index; BNP, brain natriuretic peptide; Cr, creatinine; DOAC, direct oral anticoagulant; eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction; MRA, mineralocorticoid receptor antagonists; NT-proBNP, N-terminal proBNP; SGLT2I, sodium-glucose cotransporter 2 inhibitors.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003eR, HFrEF; M, HFmrEF; P, HFpEF.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eNote: Values are expressed as median (interquartile range; 25\u003csup\u003eth\u003c/sup\u003e to 75\u003csup\u003eth\u003c/sup\u003e percentile value) for continuous variables and as percentages for categorical variables.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRegarding prescriptions at discharge, there was a median of 8 medications (IQR 6\u0026ndash;10) overall and no significant difference in LVEF. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) were prescribed more frequently in the HFrEF group than in the HFpEF group, whereas beta-blockers (BB) and sodium-glucose cotransporter 2 inhibitors (SGLT2I) were prescribed more frequently in the HFrEF and HFmrEF groups than in the HFpEF group. Tolvaptan and loop diuretics had higher prescription rates in the HFrEF group than in the HFpEF group; however, for Ca channel antagonists, the prescription rates were higher in the HFpEF group than in the HFrEF group. The prescription rates of hypoglycemic drugs, including SGLT2I, were higher in patients with HFmrEF. There were no significant differences in LVEF between mineralocorticoid receptor antagonists (MRA), antithrombotics (anticoagulants and antiplatelets), and statins.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\"\u003e\n \u003ch2\u003ePost-discharge cause-specific outcomes\u003c/h2\u003e\n \u003cp\u003eThe median observation period after discharge was 558 days (IQR 205\u0026ndash;1087). The incidence of composite events (cardiac death and HF readmission) was significantly higher in the HFrEF group than that in the HFpEF group. The 1-year composite event rates were 44.0% (95% CI: 35.2\u0026ndash;54.0) for HFrEF, 44.3% (95% CI: 32.1\u0026ndash;58.7) for HFmrEF, and 32.8% (95% CI: 26.8\u0026ndash;39.7) for HFpEF. The incidence of all-cause mortality did not differ significantly among the HFrEF, HFmrEF, and HFpEF groups (Fig.\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e, Table\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003e1-year event rate for composite outcomes and all-cause death in overall in patients with HFrEF, HFmrEF, and HFpEF.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1-year event rate, % (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHFrEF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHFmrEF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHFpEF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePairwise comparisons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eComposite endpoint\u003c/p\u003e\n \u003cp\u003e(Cardiac death\u0026thinsp;+\u0026thinsp;HF readmission)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eR\u0026thinsp;\u0026gt;\u0026thinsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(33.0\u0026ndash;43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(35.2\u0026ndash;54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(32.1\u0026ndash;58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(26.8\u0026ndash;39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAll-cause death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eR, M, P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(16.0-24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(13.1\u0026ndash;28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(10.5\u0026ndash;32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(15.2\u0026ndash;26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003eR, HFrEF; M, HFmrEF; P, HFpEF.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\"\u003e\n \u003ch2\u003ePredictors of post-discharge outcomes\u003c/h2\u003e\n \u003cp\u003eHFrEF showed no significant association with the hazard ratio for 1-year composite outcomes in the univariate analysis of each variable; however, in the multivariate analysis, there was a significant association with age. For HFmrEF, both the univariate and multivariate analyses revealed significant associations with age. HFpEF was significantly associated with age, coronary artery disease, atrial fibrillation, chronic lung disease, ACEI/ARB, BB, and MRA, whereas multivariate analysis showed significant associations only with age (Table\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e, \u003cspan\u003e4\u003c/span\u003e). In HFrEF, univariate analysis of the hazard ratios for 1-year all-cause death showed significant associations with age and ACEI/ARB use; however, multivariate analysis showed significant associations only with age. In HFmrEF, univariate analysis showed significant associations only with age; whereas multivariate analysis showed significant associations with age, coronary artery disease, CKD, chronic lung disease, and ACEI/ARB administration. HFpEF was significantly associated with age, coronary artery disease, hypertension, chronic lung disease, and ACEI/ARB use. However, multivariate analysis showed significant associations between age and chronic lung disease (Table\u0026nbsp;\u003cspan\u003e5\u003c/span\u003e, \u003cspan\u003e6\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePredictors for 1-year composite outcomes in patients with HFrEF, HFmrEF, and HFpEF (univariate analysis).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFrEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFmrEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFpEF\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02 (1.00-1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.10 (1.05\u0026ndash;1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.06 (1.03\u0026ndash;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoronary artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.09 (0.66\u0026ndash;1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62 (0.30\u0026ndash;1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.43 (0.26\u0026ndash;0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtrial fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.17 (0.71\u0026ndash;1.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.46 (0.71\u0026ndash;2.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.60 (1.05\u0026ndash;2.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85 (0.50\u0026ndash;1.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.42 (0.61\u0026ndash;3.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70 (0.44\u0026ndash;1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.80 (0.48\u0026ndash;1.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.98 (0.96\u0026ndash;4.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99 (0.62\u0026ndash;1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.06 (0.57\u0026ndash;1.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.05 (0.45\u0026ndash;2.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.68 (0.99\u0026ndash;2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic respiratory disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.01 (0.54\u0026ndash;1.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.13 (0.90\u0026ndash;5.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.69 (1.06\u0026ndash;2.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eACEI/ARB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27 (0.75\u0026ndash;2.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83 (0.40\u0026ndash;1.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.50 (0.33\u0026ndash;0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03 (0.60\u0026ndash;1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55 (0.27\u0026ndash;1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.65 (1.09\u0026ndash;2.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMRA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.74 (0.42\u0026ndash;1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.39 (0.61\u0026ndash;3.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.68 (1.03\u0026ndash;2.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers; MRA, mineralocorticoid receptor antagonists.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePredictors for 1-year composite outcomes in patients with HFrEF, HFmrEF, and HFpEF (multivariate analysis).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFrEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFmrEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFpEF\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03 (1.01\u0026ndash;1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13 (1.06\u0026ndash;1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.04 (1.02\u0026ndash;1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoronary artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.46 (0.82\u0026ndash;2.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.58 (0.55\u0026ndash;4.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.71 (0.41\u0026ndash;1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtrial fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27 (0.72\u0026ndash;2.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.44 (0.56\u0026ndash;3.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.20 (0.73\u0026ndash;1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81 (0.45\u0026ndash;1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.32 (0.46\u0026ndash;3.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.15 (0.66\u0026ndash;1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81 (0.46\u0026ndash;1.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.67 (0.70\u0026ndash;3.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.14 (0.70\u0026ndash;1.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02 (0.54\u0026ndash;1.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.39 (0.14\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.34 (0.78\u0026ndash;2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic respiratory disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.90 (0.47\u0026ndash;1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.32 (0.89\u0026ndash;6.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.44 (0.88\u0026ndash;2.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eACEI/ARB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.72 (0.94\u0026ndash;3.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73 (0.27\u0026ndash;1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.63 (0.39\u0026ndash;1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.08 (0.59\u0026ndash;1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60 (0.27\u0026ndash;1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.56 (0.99\u0026ndash;2.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMRA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64 (0.35\u0026ndash;1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.16 (0.42\u0026ndash;3.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.24 (0.75\u0026ndash;2.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers; MRA, mineralocorticoid receptor antagonists.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePredictors for 1-year all-cause death in patients with HFrEF, HFmrEF, and HFpEF (univariate analysis).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFrEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFmrEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFpEF\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.06 (1.02\u0026ndash;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.06 (1.01\u0026ndash;1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.10 (1.06\u0026ndash;1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoronary artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75 (0.41\u0026ndash;1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.96 (0.41\u0026ndash;2.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37 (0.21\u0026ndash;0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtrial fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86 (0.47\u0026ndash;1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.22 (0.52\u0026ndash;2.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.33 (0.83\u0026ndash;2.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59 (0.32\u0026ndash;1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78 (0.33\u0026ndash;1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.50 (0.31\u0026ndash;0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07 (0.58\u0026ndash;1.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.44 (0.62\u0026ndash;3.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76 (0.44\u0026ndash;1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.21 (0.58\u0026ndash;2.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62 (0.25\u0026ndash;1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03 (0.62\u0026ndash;1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic respiratory disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78 (0.35\u0026ndash;1.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.21 (0.03\u0026ndash;1.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.10 (1.30\u0026ndash;3.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eACEI/ARB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45 (0.25\u0026ndash;0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46 (0.19\u0026ndash;1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55 (0.35\u0026ndash;0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58 (0.31\u0026ndash;1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54 (0.23\u0026ndash;1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.33 (0.84\u0026ndash;2.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMRA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75 (0.38\u0026ndash;1.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.48 (0.57\u0026ndash;3.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.67 (0.98\u0026ndash;2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers; MRA, mineralocorticoid receptor antagonists.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 6\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePredictors for 1-year all-cause death in patients with HFrEF, HFmrEF, and HFpEF (multivariate analysis).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFrEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFmrEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHFpEF\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.06 (1.02\u0026ndash;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.15 (1.07\u0026ndash;1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.08 (1.05\u0026ndash;1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoronary artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.71 (0.36\u0026ndash;1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.46 (1.44\u0026ndash;29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58 (0.31\u0026ndash;1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtrial fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.88 (0.41\u0026ndash;1.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91 (0.32\u0026ndash;2.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.82 (0.48\u0026ndash;1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.71 (0.35\u0026ndash;1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.94 (0.61\u0026ndash;6.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73 (0.41\u0026ndash;1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.50 (0.74\u0026ndash;3.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.28 (0.46\u0026ndash;3.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.12 (0.62\u0026ndash;2.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.88 (0.39\u0026ndash;1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09 (0.02\u0026ndash;0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85 (0.49\u0026ndash;1.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic respiratory disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.53 (0.23\u0026ndash;1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.07 (0.01\u0026ndash;0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.89 (1.15\u0026ndash;3.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eACEI/ARB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73 (0.37\u0026ndash;1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.21 (0.05\u0026ndash;0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.94 (0.56\u0026ndash;1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.71 (0.36\u0026ndash;1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42 (0.14\u0026ndash;1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.52 (0.91\u0026ndash;2.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMRA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.84 (0.41\u0026ndash;1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.44 (0.43\u0026ndash;4.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.30 (0.74\u0026ndash;2.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers; MRA, mineralocorticoid receptor antagonists.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the clinical characteristics, medications, and outcomes of HF patients with HF from a very elderly population. While previous clinical studies of patients with ADHF have reported a mean age range of 71\u0026ndash;78 years, the median age of the patients in this study was 86 years, and many of these patients had a life expectancy longer than the average. Many patients were not included in the previous study, and studies are needed to collect and organize data on these patients in the future.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of HF patients in the super-aging society\u003c/h2\u003e \u003cp\u003eThe proportion of patients with HFpEF in this study was high (57.2%). Even within this age range, the patients were older and had a higher proportion of women than those with HFrEF. Previous clinical studies have also shown that patients with HFpEF tends to be older and more likely to be female, suggesting that the proportion of patients with HFpEF is increasing in older populations [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In contrast, in previous studies, patients with HFrEF tended to have more coronary artery disease complications than those with HFpEF, and patients with HFpEF tended to have more atrial fibrillation complications than those with HFrEF; however, no significant differences in complication rates were found in this study [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. BNP and NT-proBNP levels were similar to those reported in previous studies and tended to be higher in patients with lower LVEF.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePharmacotherapy of HF patients in a super-aging society\u003c/h2\u003e \u003cp\u003e Although the JCS guidelines recommend ACEI/ARB, BB, and MRA to improve the prognosis of HFrEF, the induction rates of ACEI/ARB, BB, and MRA tended to be low for HFrEF in this study (62.9%, 73.4%, and 29.8%, respectively). This was not sufficient compared with previous clinical studies, and age and renal function could have affected the results [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In patients with HFrEF, the incidence of composite events did not differ between those treated with and without ACEI/ARB, BB, or MRA. Previous reports have shown that guideline-based medical treatment (using both ACEI/ARB and BB: GBMT) for patients with HFrEF aged\u0026thinsp;\u0026lt;\u0026thinsp;80 years of age reduced the incidence of composite events; the present study results were similar, as there was no significant difference in the incidence of composite events between patients with HFrEF with and without GBMT for patients with HFrEF aged\u0026thinsp;\u0026gt;\u0026thinsp;80 years of age [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In contrast, in patients with HFpEF, the incidence of composite events was lower in those taking ACEI/ARB and higher in those taking BB and MRA in univariate analysis. Previous studies examining outcomes in patients with HFpEF with or without ACEI/ARB administration [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], found no significant differences in CD and HF readmission but tended to have better outcomes. Another study reported no significant differences in cardiac death or HF readmission with or without BB and MRA administration [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, in the multivariate analysis, significant differences in the presence or absence of these drugs disappeared, suggesting that age and the severity of the patient\u0026rsquo;s background may have had an effect. In terms of the incidence of all-cause death, the presence or absence of ACEI/ARB administration was significantly different in patients with HFmrEF in the multivariate analysis; however, the hazard ratio was lower in patients with CKD or chronic lung disease, which is different from the results of previous Japanese studies, suggesting that the very small number of patients (n\u0026thinsp;=\u0026thinsp;62) involved in the study was the reason for the extreme results [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eOutcomes of HF patients in a super-aging society\u003c/h2\u003e \u003cp\u003eThe in-hospital mortality rate in previous studies was 6.4-8% in Japanese cohort [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and 2.1\u0026ndash;3.4% in a European cohort [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and 3.1% in an American cohort [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], whereas in this study, it was much higher at 14.1%. This was expected because the study included very elderly patients. The 1-year overall rate of composite events was 37.7%, which was higher than the 23.7% reported previously [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and was significantly higher for HFrEF than for HFpEF. Differences in LVEF varied, with some reports showing that HFpEF was as poor as HFrEF, whereas others showed significantly worse results for HFrEF, as observed in the present study. The 1-year incidence of all-cause death varied from 7.3\u0026ndash;21.8% in previous Japanese reports [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], but tended to be higher in this study (19.7% overall). The trend toward worse outcomes (composite events and all-cause death) in the present study was likely due, in large part, to age. In contrast, the event rate for composite events was higher in the HFpEF group than in the HFrEF group, despite the older age of the patients. This may be related to the lower rate of introduction of cardioprotective agents such as ACEI/ARB, BB, and MRA. The efficacy of these agents in very elderly patients with HF, who have not been included in large clinical studies, needs to be prospectively investigated.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eOur study has several limitations. First, we collected the LVEF data during index hospitalization; however, there was no information on the exact timing of echocardiography during hospitalization, which may have been temporarily affected by co-existing conditions. The presented analysis was based on a single LVEF assessment during hospitalization and was not repeated during follow-up; therefore, we did not observe a change in LVEF. Second, treatment during hospitalization was at the discretion of the attending physician, and the prescriptions recorded were those at the time of discharge and may have been originally taken or subsequently discontinued, increased, or added. Third, during the period covered in this study, the new HF drugs angiotensin receptor neprilysin inhibitors (ARNI) and SGLT2I had not yet been indicated for the treatment of HF; therefore, the new HF drugs were not introduced, and their introduction rates were very low. Fourth, while some studies have reported worse prognoses for frail patients about HF treatment and frailty, others have suggested that patients with frailty may benefit more from HF medications [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Although this study included a very elderly population, which would be expected to have more frail patients, we were unable to collect sufficient measures of frailty and thus could not address this relationship. Fifth, HF with supernormal EF has been reported to have a poor prognosis, and care should be taken in interpreting the results of this study, since the prognosis may vary depending on whether the patient is classified as supernormal or not, even among patients classified as HFpEF [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Sixth, nursing home use may influence the event rate of HF readmission, and, information on social factors, such as information on caregiving, is needed [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The possibility that potential confounding factors may influence prognosis cannot be ruled out, so caution must be exercised in drawing the conclusion that HFpEF has a good prognosis based on the results of this study. Seventh, to examine the characteristics of HF patients in this region, we included patients with acute coronary syndrome if they met the criteria, but these patients should have been excluded to more accurately assess the association between EF and outcome. Finally, the number of patients analyzed was too small to draw a definitive conclusion, and this was an observational study conducted at a single institution.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study examined the clinical characteristics, prescriptions, and outcomes of patients with HF in a super-aging society. The median age of the patients in this study was 86 years, which makes this one of the few reports to present data on patients not included in previous evidence. The high incidence of in-hospital mortality, composite events, and all-cause mortality in this very elderly population warrants prospective consideration of appropriate treatment choices and goal setting for these patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACEI angiotensin-converting enzyme inhibitors\u003c/p\u003e\n\u003cp\u003eADHF acute decompensated heart failure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eARB angiotensin receptor blockers\u003c/p\u003e\n\u003cp\u003eBB beta-blockers\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBMI body mass index\u003c/p\u003e\n\u003cp\u003eBNP brain natriuretic peptide\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCKD chronic kidney disease\u003c/p\u003e\n\u003cp\u003eeGFR estimated glomerular filtration rate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHF heart failure\u003c/p\u003e\n\u003cp\u003eHFrEF heart failure with reduced ejection fraction\u003c/p\u003e\n\u003cp\u003eHFmrEF heart failure with mildly reduced ejection fraction\u003c/p\u003e\n\u003cp\u003eHFpEF heart failure with preserved ejection fraction\u003c/p\u003e\n\u003cp\u003eIQR interquartile ranges\u003c/p\u003e\n\u003cp\u003eLVEF left ventricular ejection fraction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMRA mineralocorticoid receptor antagonists\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNT-proBNP N-terminal proBNP\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSGLT2I sodium-glucose cotransporter 2 inhibitors\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJT, AE, YN and KT conceptualized the study design. JT, HS, KO and AM collected data. JT analyzed data and prepared the original draft of the manuscript, the tables and figures. All authors have reviewed and agreed to the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAvailability\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data relevant to the study are included in the article. Data sharing is not applicable in this study due to the restrictions of institutional review boards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional ethics committee of Saiseikai Gotsu General Hospital and conformed to the Declaration of Helsinki. The requirement for informed consent was waived by ethics committee of Saiseikai Gotsu General Hospital based on the study\u0026rsquo;s retrospective analysis of patient data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no competing interests associated with this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, Anker SD, Atherton J, B\u0026ouml;hm M, Butler J, Drazner MH, Felker GM, Filippatos G, Fiuzat M, Fonarow GC, Gomez-Mesa JE, Heidenreich P, Imamura T, Jankowska EA, Januzzi J, Khazanie P, Kinugawa K, Lam CSP, Matsue Y, Metra M, Ohtani T, Piepoli MF, Ponikowski P, Rosano GMC, Sakata Y, Seferović P, Starling RC, Teerlink JR, Vardeny O, Yamamoto K, Yancy C, Zhang J, Zieroth S. 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Circ J. 2009;73:1893-900.\u003c/li\u003e\n\u003cli\u003eSunaga A, Hikoso S, Tamaki S, Seo M. Yano M, Hayashi T, Nakagawa A, Nakagawa Y, Kurakami H, Yamada T, Kitamura T, Sato T, Oeun B, Kida H, Sotomi Y, Dohi T, Okada K, Mizuno H, Nakatani D, Yamada T, Yasumura Y, Sakata Y and OCVC-Heart Failure Investigator. Association between prognosis and the use of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers in frail patients with heart failure with preserved ejection fraction. ESC Heart Fail. 2022;9:1801-11.\u003c/li\u003e\n\u003cli\u003eOhte N, Kikuchi S, Iwahashi N, Kinugasa Y, Dohi K, Takase H, Masai\u003csup\u003e \u003c/sup\u003eK, Inoue\u003csup\u003e \u003c/sup\u003eK, Okumura\u003csup\u003e \u003c/sup\u003eT, Hachiya\u003csup\u003e \u003c/sup\u003eK, Kitada\u003csup\u003e \u003c/sup\u003eS, Seo\u003csup\u003e \u003c/sup\u003eY; EASY HFpEF Investigators. Unfavourable outcomes in patients with heart failure with higher preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging. 2023;24:293-300. \u003c/li\u003e\n\u003cli\u003eTakabayashi K, Fujita R, Iwatsu K, Ikeda T, Morikami Y, Ichinohe T, Yamamoto\u003csup\u003e \u003c/sup\u003eT, Takenaka\u003csup\u003e \u003c/sup\u003eK, Okuda\u003csup\u003e \u003c/sup\u003eM, Nakajima\u003csup\u003e \u003c/sup\u003eO, Koito\u003csup\u003e \u003c/sup\u003eH, Terasaki\u003csup\u003e \u003c/sup\u003eY, Kitamura\u003csup\u003e \u003c/sup\u003eT, Kitaguchi\u003csup\u003e \u003c/sup\u003eS, Nohara R. Impact of home- and community-based services in the long-term care insurance system on outcomes of patients with acute heart failure: Insights from the Kitakawachi Clinical Background and Outcome of Heart Failure Registry. Geriatr Gerontol Int. 2020;20:967-73.\u003c/li\u003e\n\u003c/ol\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Heart failure, Ejection fraction, Old age, Mortality, Readmission","lastPublishedDoi":"10.21203/rs.3.rs-4115717/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4115717/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn recent years, the population of very elderly heart failure (HF) patients has been rising, but there are few reports on their characteristics, treatment, and prognosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e This study included patients aged 18 years or older with acute HF admitted to a single hospital between April 1, 2016, and March 31, 2021. Patients were classified into three groups according to their echocardiographic left ventricular ejection fraction (LVEF): HF with reduced LVEF (LVEF \u0026lt; 40%: HFrEF), HF with mildly reduced LVEF (LVEF between 40% and 49%: HFmrEF), and HF with preserved LVEF (LVEF ≥ 50%: HFpEF).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 524 admitted patients, 437 were discharged, including 124 with HFrEF, 62 with HFmrEF, and 251 with HFpEF. The median age was 86 years, and patients with HFmrEF and HFpEF were older than those with HFrEF. Overall, the in-hospital mortality rate was 14.1%, the 1-year composite event rate of cardiac death and heart failure readmission was 37.7%, and the 1-year all-cause death rate was 19.7%. In particular, the composite event rate was higher in patients with HFrEF than in those with HFpEF (44.0% vs. 32.8%, P = 0.03).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe high incidence of in-hospital mortality, composite events, and all-cause mortality in this very elderly population warrants prospective consideration of appropriate treatment choices and goal setting for these patients.\u003c/p\u003e","manuscriptTitle":"Patients with acute decompensated heart failure in an area with a super-aging society; A single- center, retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-29 19:15:11","doi":"10.21203/rs.3.rs-4115717/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14bbe2d6-ef6b-4c89-870a-e339521e2d88","owner":[],"postedDate":"March 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-28T18:53:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-29 19:15:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4115717","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4115717","identity":"rs-4115717","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}