The differences between ambulatory and hospitalized heart failure patients who have mildly reduced or preserved ejection fractions: Lessons learned from the HF-POL study

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BACKGROUND: Heart failure (HF) is a leading cause of hospitalization and mortality, regardless of left ventricular ejection fraction (LVEF). The prevalence of HF with preserved and mildly reduced ejection fraction (HFpEF and HFmrEF) is rising, along with increasing hospitalizations. Patients with HF exhibit varied clinical presentations and therapeutic needs, which depend on HF status rather than solely on LVEF. The study aimed to compare the general characteristics, clinical presentation, and diagnostic features of ambulatory and hospitalized (HOSPs) patients enrolled in the HF-POL study. METHODS: HF-POL was a multicenter observational study in 14 Polish clinical centers, enrolling adult patients with HF and LVEF > 40%, either hospitalized for HF decompensation or under ambulatory care. Data collected included demographics, comorbidities, medications, physical exams, echocardiography, and additional diagnostics. RESULTS: Among the 1497 patients, 52.5% were men, with a mean age of 75 years and an LVEF of 50%. HOSPs (63.4%) were older, more likely to be women, and more frequently had a new HF diagnosis compared to ambulatory (36.6%). HOSPs had fewer previous HF hospitalizations and lower rates of coronary artery disease and prior myocardial infarction. However, they had higher rates of chronic obstructive pulmonary disease, cancer, and depression. HOSPs were more often treated with beta blockers, mineralocorticoid receptor antagonists, calcium blockers, nitrates, amiodarone, and digoxin, but less often with sodium glucose cotransporter 2 inhibitors. CONCLUSIONS: The HF-POL registry highlighted important differences between hospitalized and ambulatory HF patients, underscoring the need for individualized management, particularly during transitions from hospital to ambulatory care.

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