Differentiating Characteristics and Responses to Treatment of New-Onset Heart Failure With Preserved and Reduced Ejection Fraction in Ambulatory Patients

Background: Differences in clinical presentation and therapy out-comes between heart failure with preserved ejection fraction (HF-pEF) and heart failure with reduced ejection fraction (HFrEF) have been reported but described mainly among hospitalized patients. Be-cause the population of outpatients with heart failure (HF) is increas-ing, we sought to discriminate the clinical presentation and responses to medical therapy in ambulatory patients with new-onset HFpEF vs. HFrEF.Methods: We retrospectively included all patients with new-onset HF treated at a single HF clinic in the past 4 years. Clinical data and elec-trocardiography (ECG) and echocardiography findings were record-ed. Patients were followed up once weekly, and treatment response was evaluated according to symptoms resolution within 30 days. Uni-variate and multivariate regression analyses were performed.Results: A total of 146 patients were diagnosed with new-onset HF: 68 with HFpEF and 78 with HFrEF. The patients with HFrEF were older than those with HFpEF (66.9 vs. 62 years, respectively, P = 0.008). Patients with HFrEF were more likely to have coronary ar-tery disease, atrial fibrillation, or valvular heart disease than those with HFpEF (P < 0.05 for all). Patients with HFrEF rather than HF-pEF were more likely to present with New York Heart Association class 3 -4 dyspnea, orthopnea, paroxysmal nocturnal dyspnea or low cardiac output (P < 0.007 for all). Patients with HFpEF were more likely than those with HFpEF to have normal ECG at presentation (P < 0.001), and left bundle branch block (LBBB) was observed only in patients with HFrEF (P < 0.001). Resolution of symptoms within 30 days occurred in 75% of patients with HFpEF and 40% of patientsConclusions: Ambulatory patients with new-onset HFrEF were old-er, and had higher incidence of structural heart disease, in comparison to those with new-onset HFpEF. Patients presenting with HFrEF had more severe functional symptoms than those with HFpEF. Patients with HFpEF were more likely than those with HFpEF to have normal ECG at the time of presentation, and LBBB was strongly associated with HFrEF. Outpatients with HFrEF rather than HFpEF were less likely to respond to treatment.