To the Editor,

We read with great interest the editorial by Doughty1 concerning the prognosis of patients with heart failure and preserved ejection fraction published in your journal, in which the author points out that the majority of the patients included in clinical trials do not represent the real situation encountered in clinical practice. This fact is especially relevant in hospital emergency departments. Recently, our working group analyzed the data of the Epidemiology Acute Heart Failure Emergency (EAHFE) study,2, 3 a project involving 9 hospitals in which all the patients diagnosed as having acute heart failure admitted to a hospital emergency department over a 2-month period were consecutively enrolled. Data were collected on the clinical profile of each patient and on the short-term outcome (in-hospital mortality, 30-day mortality, and 30-day follow-up visit). A retrospective investigation was carried out to determine whether there was a previous echocardiogram and, when available, whether the left ventricular ejection fraction had been quantified. In addition, ventricular function was defined as depressed or preserved depending on whether the ejection fraction was ≤45% or >45%, respectively. Of the 997 patients included, 547 (54.9%) had undergone echocardiography and the status of the ventricular function was known in 476: it was depressed in 273 (57.4%) and preserved in 203 (42.6%). Among the patients with depressed systolic function, there were more men, young people, active smokers, individuals with ischemic heart disease, and those with signs of left heart failure. No significant differences were observed between the outcomes of patients with preserved and depressed systolic in terms of any of the three parameters evaluated (in-hospital mortality, 4.4% and 4.3%, respectively [P=.67]; 30-day mortality, 9.5% and 9.4%, respectively [P=.95]; 30-day follow-up visit, 28.2% and 24.6%, respectively [P=.38]). The odds ratios for all these comparisons were always very close to 1, results very similar to those of other registries such as the OPTIMIZE-HF Registry.4 Thus, we agree with the author of the editorial in that individuals with heart failure and preserved ejection fraction are an important group of patients, even in the context of hospital emergency departments, although we found a similar mortality rate in both groups.

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Corresponding author: 32229fjr@gmail.com