Clinical Phenotypes and Age-Related Differences in Presentation, Treatment, and Outcome of Heart Failure with Preserved Ejection Fraction: A Vietnamese Multicenter Research

Abstract

Background. Heart failure with preserved ejection fraction (HFpEF) is a rising health problem with heterogeneous presentation and no evidence-based treatment. While Southeast Asia reported the highest mortality and morbidity among Asian population, little is known about the Vietnamese population, including patient characteristics, prescribing pattern and mortality rate. Methods. We conducted an observational study on 477 patients diagnosed with HFpEF from seven hospitals in Southern Vietnam from January 2019 to December 2019. Results. Mean age was 67.6 (40.9% < 65 years). 62.3% were female. 82.4% were diagnosed within 5 years. Dyspnea, congestion, and hypoperfusion on admission were noted in 63.9%, 48.8%, and 4.6% of the patients, respectively. Median ejection fraction was 63%. Valvular heart disease (VHD) was the leading cause of heart failure (35.9%). 78.6% had at least two comorbidities, mostly hypertension (68.6%). 30.6% of the patients were hospitalized, with a median stay of 7.0 (4.0–10.0) days and inhospital mortality of 4.8%. Older patients (≥65 years) were more likely to be females (OR = 1.52); had multimorbid conditions (OR = 3.14), including hypertension (OR = 4.28), diabetes (OR = 1.73), coronary artery disease (CAD) (OR = 2.50), dyslipidemia (OR = 1.94), and chronic kidney disease (OR = 2.44); and were more frequently prescribed statin (OR = 3.15). Younger individuals (<65 years) were associated with higher mineralocorticoid antagonist uptake (OR = 0.52) and VHD (OR = 0,40). Prescription rate for renin-angiotensin-aldosterone system inhibitor, beta blocker, mineralocorticoid antagonist, and loop diuretic was 72.5%, 59.1%, 43.0%, and 60.6%, respectively. Four phenotypes were identified, including the lean/elderly/multimorbid; congestive/metabolic; CAD-induced; and younger/atrial fibrillation (AF)/VHD. The novel phenotype “younger/AF/VHD” exhibited high symptom burden and poor functional capacity despite being the youngest and least multimorbid. The “lean/elderly/multimorbid” phenotype demonstrated the highest symptom severity and inhospital mortality. Conclusions. Our research highlights a younger, predominantly female population with high disease burden. The four novelly identified phenotypes provide contemporary and pragmatic insights into a phenotype-guided approach, exclusively targeting the Vietnamese population.

Prognostic significance of dipstick proteinuria in heart failure with preserved ejection fraction: insight from the PURSUIT-HFpEF registry

“…We excluded cases with cardiac amyloidosis or sarcoidosis or pulmonary arterial hypertension from this analysis, as well as cases with severe valvular diseases from the registry because of their markedly different characteristics, specific haemodynamic and pathophysiological features from common HFpEF. Most randomised clinical trials [19][20][21] and observational studies 22 of HFpEF have excluded these cases. Consequently, we analysed 851 discharged-alive cases and classified them into two groups according to the absence (502 cases, 59%) or presence (349 cases, 41%) of proteinuria (figure 1).…”

Impact of Novel Guidelines on Multifactorial Control and Its Association with Mortality in Adult Patients with Hypertension and Newly Diagnosed Type 2 Diabetes: A 4-Year Prospective Multicenter Study

“…Our study demonstrated a higher proportion of multimorbidity (≥2 coexisting diseases) in patients >75 years (59.2%) as opposed to younger individuals (28.4%, p < 0.001). While the number of comorbid conditions alone was insufficient to fully expound adverse consequences in aging individuals with high cardiovascular risk [ 39 ], it did make a remarkable contribution to the worsening of overall health status. Therefore, the number of comorbidities could be considered as a simple indicator to forewarn physicians of imminently drastic deterioration in multimorbid elderly.…”

Different heart failure phenotypes of valvular heart disease: the role of mitochondrial dysfunction

“…Indeed, a multicenter study in a Vietnamese population found that VHD was one of the common causes of HFpEF. These patients were younger and had fewer comorbidities, but they had earlier cardiovascular events and worse prognosis (55). Accumulating evidence showed that the incidence of VHD-related HFpEF ranged from 11.0% to 86.8% (9,51,(55)(56)(57).…”

“…These patients were younger and had fewer comorbidities, but they had earlier cardiovascular events and worse prognosis (55). Accumulating evidence showed that the incidence of VHD-related HFpEF ranged from 11.0% to 86.8% (9,51,(55)(56)(57). VHD-related HFpEF was mainly caused by left heart valve damage, especially AS (58).…”