Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 16, Number 3, June 2025, pages 267-277

Epidemiology and Short-Term Outcomes of Heart Failure With Preserved and Mildly Reduced Ejection Fraction in Colombia: Insights of the Colombian Heart Failure Registry (RECOLFACA)

Figure 1. Clinical, echocardiographic, laboratory, and pharmacological differences between patients with HFpEF/HFmrEF and HFrEF. HFpEF: heart failure with preserved ejection fraction; HFmrEF: heart failure with mildly reduced ejection fraction; HFrEF: heart failure with reduced ejection fraction.

Figure 2. Kaplan-Meier survival curves comparing patients with HFpEF/HFmrEF versus HFrEF. HFpEF: heart failure with preserved ejection fraction; HFmrEF: heart failure with mildly reduced ejection fraction; HFrEF: heart failure with reduced ejection fraction.

**Table 1.** Baseline Characteristics According to the Ejection Fraction Classification
	HFpEF/HFmrEF (n = 1,139), n (%)	HFrEF (n = 1,375), n (%)	Total (n = 2,514)	P value
ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; ARNI: angiotensin receptor neprilysin inhibitor; CABG: coronary artery bypass graft; COPD: chronic obstructive pulmonary disease; CRT: cardiac resynchronization therapy; eGFR: estimated glomerular filtration rate; HFmrEF: heart failure with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction; HRQL: health-related quality of life; ICD: implantable cardiac defibrillator; IQR: interquartile range; LVEF: left ventricular ejection fraction; MRAs: mineralocorticoid receptor antagonists; NT-proBNP: N-terminal pro-brain natriuretic peptide.
Sex, male	628 (55.1)	819 (59.6)	1,447 (57.6)	0.025
Age, years (median (IQR))	71 (61, 80)	68 (58, 76)	69 (59, 78)	< 0.001
Ethnicity				0.013
Asian	1 (0.1)	0 (0.0)	1 (0.0)
White	57 (5.0)	59 (4.3)	116 (4.6)
Indigenous	5 (0.4)	5 (0.4)	10 (0.4)
Hispanic	871 (76.5)	982 (71.4)	1,853 (73.7)
Mestiza	177 (15.5)	281 (20.4)	458 (18.2)
African American	28 (2.5)	48 (3.5)	76 (3.0)
Procedence				0.056
Rural	290 (25.5)	397 (28.9)	687 (27.3)
Urban	849 (74.5)	978 (71.1)	1,827 (72.7)
Comorbidities
Arterial hypertension	854 (75.0)	957 (69.6)	1,811 (72.0)	0.003
Alcoholism	33 (2.9)	53 (3.9)	86 (3.4)	0.189
Smoking	196 (17.2)	256 (18.6)	452 (17.9)	0.359
Type 2 diabetes mellitus	277 (24.3)	343 (24.9)	620 (24.7)	0.717
Liver disease	6 (0.5)	5 (0.4)	11 (0.4)	0.537
Coronary heart disease	319 (28.0)	387 (28.1)	706 (28.1)	0.939
COPD	240 (21.1)	201 (14.6)	441 (17.5)	< 0.001
Atrial fibrillation	275 (24.1)	285 (20.7)	560 (22.3)	0.040
Thyroid disease	190 (16.7)	198 (14.4)	388 (15.4)	0.115
Chronic kidney disease	186 (16.3)	248 (18.0)	434 (17.3)	0.260
Valvular heart disease	220 (19.3)	209 (15.2)	429 (17.1)	0.006
CABG	89 (7.8)	81 (5.9)	170 (6.8)	0.056
Dyslipidemia	290 (25.5)	357 (26.0)	647 (25.7)	0.774
Chagas disease	34 (3.0)	54 (3.9)	88 (3.5)	0.201
HF etiology
Hypertensive	401 (35.2)	403 (29.3)	804 (32.0)	0.001
Toxic	7 (0.6)	6 (0.4)	13 (0.5)	0.533
Ischemic	489 (42.9)	623 (45.3)	1,112 (44.2)	0.252
Unknown	0 (0.0)	0 (0.0)	0 (0.0)	-
Valvular	176 (15.5)	155 (11.3)	331 (13.2)	0.002
Other	0 (0.0)	0 (0.0)	0 (0.0)	-
Chemotherapy	8 (0.7)	9 (0.7)	17 (0.7)	0.881
Idiopathic	76 (6.7)	149 (10.8)	225 (8.9)	0.000
Tachycardiomyopathy	30 (2.6)	36 (2.6)	66 (2.6)	0.973
Metabolic	6 (0.5)	10 (0.7)	16 (0.6)	0.532
Chagasic	33 (2.9)	55 (4.0)	88 (3.5)	0.137
Congenital	10 (0.9)	5 (0.4)	15 (0.6)	0.095
Viral	9 (0.8)	11 (0.8)	20 (0.8)	0.982
Genetic	7 (0.6)	6 (0.4)	13 (0.5)	0.533
Peripartum	3 (0.3)	5 (0.4)	8 (0.3)	0.736
Alcoholic	0 (0.0)	2 (0.1)	2 (0.1)	0.504
NYHA classification				0.113
I	128 (11.2)	170 (12.4)	298 (11.9)
II	632 (55.5)	718 (52.2)	1,350 (53.7)
III	336 (29.5)	411 (29.9)	747 (29.7)
IV	43 (3.8)	76 (5.5)	119 (4.7)
AHA/ACC stage				0.008
C	1,092 (95.9)	1,285 (93.5)	2,377 (94.6)
D	47 (4.1)	90 (6.5)	137 (5.4)
Previous cardiovascular treatment
ACEI	343 (30.1)	503 (36.6)	846 (33.7)	< 0.001
ARB	557 (48.9)	512 (37.2)	1,069 (42.5)	< 0.001
Diuretics	719 (63.1)	974 (70.8)	1,693 (67.3)	< 0.001
Beta-blockers	965 (84.7)	1,224 (89.0)	2,189 (87.1)	0.001
ARNIs	65 (5.7)	180 (13.1)	245 (9.7)	< 0.001
MRAs	466 (40.9)	933 (67.9)	1,399 (55.6)	< 0.001
Ivabradine	33 (2.9)	117 (8.5)	150 (6.0)	< 0.001
Digoxin	82 (7.2)	169 (12.3)	251 (10.0)	< 0.001
Nitrates	35 (3.1)	56 (4.1)	91 (3.6)	0.182
Antiplatelet therapy	528 (46.4)	632 (46.0)	1,160 (46.1)	0.844
Statins use	643 (56.5)	748 (54.4)	1,391 (55.3)	0.303
Anticoagulant therapy	318 (27.9)	325 (23.6)	643 (25.6)	0.014
Pacemaker				0.018
Bicameral	54 (4.7)	44 (3.2)	98 (3.9)
Unicameral	29 (2.5)	20 (1.5)	49 (1.9)
CRT	15 (1.3)	33 (2.4)	48 (1.9)	< 0.001
ICD	78 (6.8)	165 (12.0)	243 (9.7)	< 0.001
CRT + ICD	37 (3.2)	90 (6.5)	127 (5.1)
Vital signs, echo variables, and laboratory results
Systolic blood pressure (median (IQR))	120 (110 - 138)	118 (102 - 130)	120 (106 - 134)	< 0.001
Heart rate (median (IQR))	71 (64 - 80)	72 (65 - 82)	72 (65 - 81)	0.044
HRQL score (median (IQR))	80 (65 - 100)	80 (60 - 100)	80 (65 - 100)	0.209
LV end-diastolic diameter (median (IQR))	48 (43 - 55)	60 (53 - 67)	57 (48 - 65)	< 0.001
LVEF (median (IQR))	49 (43 - 56)	27 (20 - 33)	33 (25 - 42)	< 0.001
Hemoglobin (mg/dL) (median (IQR))	13 (11.4 - 14.1)	13 (11.8 - 14.5)	13 (11.6 - 14.3)	0.004
eGFR (median (IQR))	59.71 (43.84 - 79.48)	56.49 (41.69 - 74.72)	57.45 (42.56 - 77.38)	0.006
NT-proBNP (median (IQR))	1,917 (838.750 - 4,163.250)	2,762 (1,010.8 - 7,414.8)	2,255.5 (954 - 5,593.75)	0.012
Pulmonary hypertension	277 (45.8)	613 (49.9)	890 (48.6)	0.096
Hyperkalemia	70 (8.5)	106 (10.1)	176 (9.4)	0.226
Hyponatremia	126 (16.6)	114 (11.9)	240 (14)	0.006
Prolonged QRS duration	204 (34.2)	299 (40.4)	503 (37.7)	0.021

Table 1. Baseline Characteristics According to the Ejection Fraction Classification

HFpEF/HFmrEF (n = 1,139), n (%)

HFrEF (n = 1,375), n (%)

Total (n = 2,514)

P value

ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; ARNI: angiotensin receptor neprilysin inhibitor; CABG: coronary artery bypass graft; COPD: chronic obstructive pulmonary disease; CRT: cardiac resynchronization therapy; eGFR: estimated glomerular filtration rate; HFmrEF: heart failure with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction; HRQL: health-related quality of life; ICD: implantable cardiac defibrillator; IQR: interquartile range; LVEF: left ventricular ejection fraction; MRAs: mineralocorticoid receptor antagonists; NT-proBNP: N-terminal pro-brain natriuretic peptide.

Sex, male

628 (55.1)

819 (59.6)

1,447 (57.6)

0.025

Age, years (median (IQR))

71 (61, 80)

68 (58, 76)

69 (59, 78)

< 0.001

Ethnicity

0.013

Asian

1 (0.1)

0 (0.0)

1 (0.0)

White

57 (5.0)

59 (4.3)

116 (4.6)

Indigenous

5 (0.4)

10 (0.4)

Hispanic

871 (76.5)

982 (71.4)

1,853 (73.7)

Mestiza

177 (15.5)

281 (20.4)

458 (18.2)

African American

28 (2.5)

48 (3.5)

76 (3.0)

Procedence

0.056

Rural

290 (25.5)

397 (28.9)

687 (27.3)

Urban

849 (74.5)

978 (71.1)

1,827 (72.7)

Comorbidities

Arterial hypertension

854 (75.0)

957 (69.6)

1,811 (72.0)

0.003

Alcoholism

33 (2.9)

53 (3.9)

86 (3.4)

0.189

Smoking

196 (17.2)

256 (18.6)

452 (17.9)

0.359

Type 2 diabetes mellitus

277 (24.3)

343 (24.9)

620 (24.7)

0.717

Liver disease

6 (0.5)

5 (0.4)

11 (0.4)

0.537

Coronary heart disease

319 (28.0)

387 (28.1)

706 (28.1)

0.939

COPD

240 (21.1)

201 (14.6)

441 (17.5)

< 0.001

Atrial fibrillation

275 (24.1)

285 (20.7)

560 (22.3)

0.040

Thyroid disease

190 (16.7)

198 (14.4)

388 (15.4)

0.115

Chronic kidney disease

186 (16.3)

248 (18.0)

434 (17.3)

0.260

Valvular heart disease

220 (19.3)

209 (15.2)

429 (17.1)

0.006

CABG

89 (7.8)

81 (5.9)

170 (6.8)

0.056

Dyslipidemia

290 (25.5)

357 (26.0)

647 (25.7)

0.774

Chagas disease

34 (3.0)

54 (3.9)

88 (3.5)

0.201

HF etiology

Hypertensive

401 (35.2)

403 (29.3)

804 (32.0)

0.001

Toxic

7 (0.6)

6 (0.4)

13 (0.5)

0.533

Ischemic

489 (42.9)

623 (45.3)

1,112 (44.2)

0.252

Unknown

0 (0.0)

Valvular

176 (15.5)

155 (11.3)

331 (13.2)

0.002

Other

0 (0.0)

Chemotherapy

8 (0.7)

9 (0.7)

17 (0.7)

0.881

Idiopathic

76 (6.7)

149 (10.8)

225 (8.9)

0.000

Tachycardiomyopathy

30 (2.6)

36 (2.6)

66 (2.6)

0.973

Metabolic

6 (0.5)

10 (0.7)

16 (0.6)

0.532

Chagasic

33 (2.9)

55 (4.0)

88 (3.5)

0.137

Congenital

10 (0.9)

5 (0.4)

15 (0.6)

0.095

Viral

9 (0.8)

11 (0.8)

20 (0.8)

0.982

Genetic

7 (0.6)

6 (0.4)

13 (0.5)

0.533

Peripartum

3 (0.3)

5 (0.4)

8 (0.3)

0.736

Alcoholic

0 (0.0)

2 (0.1)

0.504

NYHA classification

0.113

128 (11.2)

170 (12.4)

298 (11.9)

632 (55.5)

718 (52.2)

1,350 (53.7)

III

336 (29.5)

411 (29.9)

747 (29.7)

43 (3.8)

76 (5.5)

119 (4.7)

AHA/ACC stage

0.008

1,092 (95.9)

1,285 (93.5)

2,377 (94.6)

47 (4.1)

90 (6.5)

137 (5.4)

Previous cardiovascular treatment

ACEI

343 (30.1)

503 (36.6)

846 (33.7)

< 0.001

ARB

557 (48.9)

512 (37.2)

1,069 (42.5)

< 0.001

Diuretics

719 (63.1)

974 (70.8)

1,693 (67.3)

< 0.001

Beta-blockers

965 (84.7)

1,224 (89.0)

2,189 (87.1)

0.001

ARNIs

65 (5.7)

180 (13.1)

245 (9.7)

< 0.001

MRAs

466 (40.9)

933 (67.9)

1,399 (55.6)

< 0.001

Ivabradine

33 (2.9)

117 (8.5)

150 (6.0)

< 0.001

Digoxin

82 (7.2)

169 (12.3)

251 (10.0)

< 0.001

Nitrates

35 (3.1)

56 (4.1)

91 (3.6)

0.182

Antiplatelet therapy

528 (46.4)

632 (46.0)

1,160 (46.1)

0.844

Statins use

643 (56.5)

748 (54.4)

1,391 (55.3)

0.303

Anticoagulant therapy

318 (27.9)

325 (23.6)

643 (25.6)

0.014

Pacemaker

0.018

Bicameral

54 (4.7)

44 (3.2)

98 (3.9)

Unicameral

29 (2.5)

20 (1.5)

49 (1.9)

CRT

15 (1.3)

33 (2.4)

48 (1.9)

< 0.001

ICD

78 (6.8)

165 (12.0)

243 (9.7)

< 0.001

CRT + ICD

37 (3.2)

90 (6.5)

127 (5.1)

Vital signs, echo variables, and laboratory results

Systolic blood pressure (median (IQR))

120 (110 - 138)

118 (102 - 130)

120 (106 - 134)

< 0.001

Heart rate (median (IQR))

71 (64 - 80)

72 (65 - 82)

72 (65 - 81)

0.044

HRQL score (median (IQR))

80 (65 - 100)

80 (60 - 100)

80 (65 - 100)

0.209

LV end-diastolic diameter (median (IQR))

48 (43 - 55)

60 (53 - 67)

57 (48 - 65)

< 0.001

LVEF (median (IQR))

49 (43 - 56)

27 (20 - 33)

33 (25 - 42)

< 0.001

Hemoglobin (mg/dL) (median (IQR))

13 (11.4 - 14.1)

13 (11.8 - 14.5)

13 (11.6 - 14.3)

0.004

eGFR (median (IQR))

59.71 (43.84 - 79.48)

56.49 (41.69 - 74.72)

57.45 (42.56 - 77.38)

0.006

NT-proBNP (median (IQR))

1,917 (838.750 - 4,163.250)

2,762 (1,010.8 - 7,414.8)

2,255.5 (954 - 5,593.75)

0.012

Pulmonary hypertension

277 (45.8)

613 (49.9)

890 (48.6)

0.096

Hyperkalemia

70 (8.5)

106 (10.1)

176 (9.4)

0.226

Hyponatremia

126 (16.6)

114 (11.9)

240 (14)

0.006

Prolonged QRS duration

204 (34.2)

299 (40.4)

503 (37.7)

0.021

**Table 2.** Independent Predictors of All-Cause Mortality According to the Ejection Fraction Classification
	HR (95% CI)	P-value
ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; HFmrEF: heart failure with mildly reduced ejection fraction; CI: confidence interval; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction; HR: hazard ratio; HRQL: health-related quality of life.
HFpEF/HFmrEF
ACEI/ARB	0.44 (0.26 - 0.74)	0.002
Hemoglobin (mg/dL)	0.88 (0.78 - 0.99)	0.035
Chagas disease diagnosis	3.86 (1.53 - 9.74)	0.004
HRQL score	0.97 (0.96 - 0.98)	< 0.001
HFrEF
Systolic blood pressure (mm Hg)	0.98 (0.96 - 0.99)	< 0.001
Nitrates use	4.03 (2.04 - 7.96)	< 0.001
Hyperkalemia	2.58 (1.45 - 4.59)	0.001
Multimorbidity (per comorbidity)	1.29 (1.13 - 1.49)	< 0.001
HRQL score	0.98 (0.97 - 0.99)	< 0.001

Table 2. Independent Predictors of All-Cause Mortality According to the Ejection Fraction Classification

HR (95% CI)

P-value

ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; HFmrEF: heart failure with mildly reduced ejection fraction; CI: confidence interval; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction; HR: hazard ratio; HRQL: health-related quality of life.

HFpEF/HFmrEF

ACEI/ARB

0.44 (0.26 - 0.74)

0.002

Hemoglobin (mg/dL)

0.88 (0.78 - 0.99)

0.035

Chagas disease diagnosis

3.86 (1.53 - 9.74)

0.004

HRQL score

0.97 (0.96 - 0.98)

< 0.001

HFrEF

Systolic blood pressure (mm Hg)

0.98 (0.96 - 0.99)

< 0.001

Nitrates use

4.03 (2.04 - 7.96)

< 0.001

Hyperkalemia

2.58 (1.45 - 4.59)

0.001

Multimorbidity (per comorbidity)

1.29 (1.13 - 1.49)

< 0.001

HRQL score

0.98 (0.97 - 0.99)

< 0.001