D‐dimer and outcomes in hospitalized heart failure patients across the ejection fraction phenotypes

AIMS: The prognostic significance of D‐dimer in hospitalized heart failure (HF) patients is incompletely characterized. We aimed to assess the association of D‐dimer levels on admission with adverse events at follow‐up in patients hospitalized with HF across all ejection fraction (EF) phenotypes. METHODS AND RESULTS: Consecutive patients hospitalized from December 2006 to December 2017 for HF with D‐dimer and EF values available (n = 1795) were enrolled. Associations between D‐dimer and all‐cause death were examined at 1‐year follow‐up. Median age was 57 years, 73.4% were male, and the majority (72.1%) were in New York Heart Association Classes III–IV. EF was reduced in 53.3% (HFrEF), mildly reduced in 16.3% (HFmrEF), and preserved in 30.4% (HFpEF). Median (interquartile range) D‐dimer on admission was 0.56 (0.27–1.295) μg/mL FEU (fibrinogen‐equivalent unit) in the whole cohort, 0.64 (0.28–1.48) μg/mL FEU in HFrEF, 0.50 (0.27–1.03) μg/mL FEU in HFmrEF, and 0.495 (0.25–1.10) μg/mL FEU in HFpEF (P = 0.001). At 1‐year follow‐up, higher D‐dimer (D‐dimer ≥0.56 μg/mL FEU) independently predicted all‐cause death in total cohort [hazard ratio (HR) 1.55; 95% confidence interval (CI), 1.15–2.1], in HFrEF (HR, 1.49; P = 0.039), and in HFpEF (HR, 2.06; P = 0.033). However, no relationship was found for HFrEF or HFmrEF when D‐dimer was treated as quartiles. In sensitivity analysis, quantitatively similar but more pronounced association between D‐dimer and all‐cause death was observed in total cohort and HFpEF cohort. CONCLUSIONS: In hospitalized HF patients, higher D‐dimer concentration was a significant and independent predictor of 1‐year all‐cause mortality. Across all HF phenotypes, this effect was most evident in HFpEF patients.