Congestive heart failure with preserved systolic function in a statewide sample of community hospitals

Background: The importance of congestive heart failure (CHF) in patients wi th preserved left ventricular systolic function is increasingly recognized, but most studies have been conducted at a single, usually academic, medica l center. The aim of this study was to determine the prognosis, readmission rate, and effect of ACE inhibitor therapy in a Medicare cohort with CHF an d preserved systolic function. Methods and Results: We examined a statewide, random sample of 1,720 Califo rnia Medicare patients hospitalized with an ICD-9 diagnosis of CHF confirme d by a decreased left ventricular ejection fraction (EF) or chest radiograp h from July 1993 to June 1994 and January 1996 to June 1996. Among the 782 patients with confirmed CHF and an in-hospital left ventricular EF measurem ent, 45% had reduced systolic function (RcSF) (EF < 40%) and 55% had preser ved systolic function (PrSF) (EF > 40%). The PrSF group had a lower 1-year mortality rate but similar hospital readmission rates for both CHF and all causes. In patients with RcSF, ACE inhibitor treatment was associated with a lower mortality rate (P = .04) and a trend toward a lower CHF readmission rate (P = .13). In contrast, ACE inhibition therapy was associated with ne ither a lower rate of mortality nor CHF readmission in PrSF patients (P = . 61 and .12, respectively). In multivariate analyses treatment with ACE inhi bitors in PrSF patients was not associated with either a reduction in morta lity (hazard ratio, 1.15; 95% CI, 0.79-1.67) or CHF readmission (hazard rat io, 1.21; 95% CI, 0.92-1.58). Conclusions: CHF with PrSF seems to be associated with high mortality and m orbidity rates, but ACE inhibitors may not produce comparable benefit in th is group as in patients with ReSF.