Outcomes in world health organization group II pulmonary hypertension: Mortality and readmission trends with systolic and preserved ejection fraction-induced pulmonary hypertension

Background Heart failure with preserved ejection fraction (HFpEF) has been increasingly recognized as a leading cause of pulmonary hypertension (HFpEF-PH). It remains unknown how HFpEF-PH fares in relation to systolic HF (reduced ejection fraction)-induced PH (HFrEF-PH). Therefore, we sought to determine the long-term morbidity and mortality of HFpEF-PH and HFrEF-PH. Methods and Results We studied all patients over a 6-year period with symptomatic HF and severe PH (PASP 65 mm Hg) in The Bronx, New York. We classified patients as having either preserved (50%) or reduced (≤35%) left ventricular ejection fraction. Trends in mortality and HF readmission rates were defined in 650 patients (HFrEF-PH: n = 277; HFpEF-PH: n = 373). HFpEF-PH patients were older and more often female and white. HFrEF-PH patients were more often black, had ischemic cardiomyopathy, and were on typical HF drug regimens. Patients with HFpEF-PH had a significantly increased all-cause 5-year mortality (52% vs 42%; P =.024). HFpEF-PH was a significant predictor of mortality (adjusted hazard ratio 1.70; P =.012). Patients with HFrEF-PH had more HF readmissions (1) than patients with HFpEF-PH (28.6% vs 15%; P =.003), especially within the 1st year (9.1% vs 1.7%; P =.005). Conclusions Patients with HFrEF-PH and HFpEF-PH have a significantly elevated long-term mortality, with HFpEF-PH having a higher 5-year mortality rate. These findings testify to the overall poor prognosis of World Health Organization Group II PH, especially HFpEF-PH.