Epidemiology of Heart Failure with Preserved Ejection Fraction

Abstract

Heart failure with preserved ejection fraction (HFPEF) is a common condition, especially among the elderly and in women, with the reported prevalence approaching 10% in women over the age of 80 years. With an increasing prevalence of hypertension, obesity, atrial fibrillation, and diabetes, and the growing elderly segment of the general population, the prevalence of HFPEF is projected to increase further. HFPEF presents a diagnostic challenge. As a consequence, studies differ widely in their reported incidence and mortality rates associated with this condition, although there is agreement that between a third and one half of heart failure patients in the community have HFPEF. Although several consensus statements and guidelines have been published during the last decade, some of the recent randomized clinical trials have reported low mortality rates, raising doubts whether all patients diagnosed with HFPEF do actually suffer from HFPEF (as opposed to misdiagnosis) or if the condition is heterogeneous by nature in terms of its etiology and prognosis. The overall reported prognosis of patients with HFPEF remains poor, with patients experiencing substantial comorbidity, high rates of repeated hospitalizations, and a high mortality. In both community-based and hospital-based cohorts, HFPEF was recently reported to be associated with approximately 159 (154–165) deaths per 1000 person-years.

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure

“…In contrast, patients with HFrEF were more likely than those with HFpEF to have severe coronary artery disease (CAD; 38% vs 23%) and smoke (51% vs 48%). These characteristics were in alignment with those from major epidemiological studies, thus supporting generalizability of our HFpEF and HFrEF cohorts to broader populations 44, 45…”

Heart failure as a predictor of functional dependence in hospitalized elderly

“…In most forms of HF, the reduction in cardiac output is responsible for inadequate tissue perfusion. However, not all seniors will present low ejection fraction (12)(13) . Unlike the presentation of HF in young adults, a condition where the systolic dysfunction is the cause of significant pathology in the elderly clinical manifestations often occurs with preserved systolic function of the left ventricle, corroborating findings of this study, and there is therefore higher expressiveness of low LVEF (14) .…”

Sacubitril/valsartan for chronic heart failure: its future potential

“…16 Most of the success to date has been in patients with reduced ejection fraction but heart failure with preserved ejection fraction accounts for around half of cases and its prevalence appears to be growing. 17 Treatment is less successful than when ejection fraction is reduced. Drug treatment focuses on symptom relief and has not been shown to reduce mortality, morbidity or improve exercise intolerance.…”