Long term outcomes in patients with heart failure
The Darlington Retrospective Out Patient Study (DROPSY)

Abstract

The Darlington Retrospective Outpatient Study (DROPSY) was carried out at the Darlington Memorial Hospital Darlington. From Jan 2002 to Dec 2007, 1041 patients were seen in the heart failure (HF) clinic. Of these 270 (26%) were diagnosed as having left ventricular systolic dysfunction (LVSD). Of the 771 patients who did not have systolic dysfunction, we identified 243 patients who fulfilled the study criteria for heart failure with preserved ejection fraction (HFpEF). The remaining 528 patients formed the non heart failure (Other) group.
Patients with HFpEF were older and more likely to have hypertension and diabetes than the other two groups. The LVSD group had more men plus ischemic heart disease patients while the third group of non HF also had more females and a high number with COPD.
Over the mean follow up of 7 years, the number of admissions to hospital per patient was similar in both the LVSD and HFpEF groups, but HFpEF patients had a significantly longer length of stay. In the HFpEF group, the use of beta blockers, ACE inhibitors, and a lower median resting HR of < 78 / min predicted better survival. All cause mortality was high in both LVSD and HFpEF groups, with strikingly different cause of death. Patients with LVSD had more cardiovascular deaths whereas HFpEF patients were more likely to die of non cardiovascular causes. Patients in the third group diagnosed as not having HF (Other group) also had high five year mortality.
Conclusion
Patients with LVSD and HFpEF have high mortality but different causes of death. The use of beta blockers, ACE inhibitors, and a lower resting heart rate in the HFpEF group was associated with better survival. Patients who were reassured as not having HF do badly as well.