Epidemiology, Pathophysiology, Diagnosis, and Therapy of Heart Failure With Preserved Ejection Fraction in Japan

Obokata, Masaru; Sorimachi, Hidemi; Harada, Tomonari; Kagami, Kazuki; Saito, Yuki; Ishii, Hideki

doi:10.1016/j.cardfail.2022.09.018

Cited by 20 publications

(6 citation statements)

References 123 publications

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“…However, the applicability of findings from Japanese studies on BB therapy in HFpEF to other ethnic groups may be impacted by several factors, including genetic differences, variations in population health profiles, lifestyle and environmental factors, and the different prevalence of comorbid conditions. As observed by Obokata et al, Japanese people living with HFpEF show relevant phenotypic differences from Western HFpEF patients, including lower rates of obesity and higher rates of DM, AF, and CRF [76].…”

Section: Beta Blockers In Older Adults With Predominantly Hfpefmentioning

confidence: 76%

How to Manage Beta-Blockade in Older Heart Failure Patients: A Scoping Review

Parrini,

Lucà,

Rao

et al. 2024

JCM

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Beta blockers (BBs) play a crucial role in enhancing the quality of life and extending the survival of patients with heart failure and reduced ejection fraction (HFrEF). Initiating the therapy at low doses and gradually titrating the dose upwards is recommended to ensure therapeutic efficacy while mitigating potential adverse effects. Vigilant monitoring for signs of drug intolerance is necessary, with dose adjustments as required. The management of older HF patients requires a case-centered approach, taking into account individual comorbidities, functional status, and frailty. Older adults, however, are often underrepresented in randomized clinical trials, leading to some uncertainty in management strategies as patients with HF in clinical practice are older than those enrolled in trials. The present article performs a scoping review of the past 25 years of published literature on BBs in older HF patients, focusing on age, outcomes, and tolerability. Twelve studies (eight randomized-controlled and four observational) encompassing 26,426 patients were reviewed. The results indicate that BBs represent a viable treatment for older HFrEF patients, offering benefits in symptom management, cardiac function, and overall outcomes. Their role in HF with preserved EF, however, remains uncertain. Further research is warranted to refine treatment strategies and address specific aspects in older adults, including proper dosing, therapeutic adherence, and tolerability.

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Section: Beta Blockers In Older Adults With Predominantly Hfpefmentioning

confidence: 76%

How to Manage Beta-Blockade in Older Heart Failure Patients: A Scoping Review

Parrini,

Lucà,

Rao

et al. 2024

JCM

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“…Given the small number of events, the included potential confounders in the multivariable analysis were limited. The profiles of HFpEF may vary depending on legions and ethics [ 29 ]. For example, few HFpEF patients in the Asian lesion have obesity.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Modified H2FPEF Score in Patients Receiving Trans-Catheter Aortic Valve Replacement

Akao,

Imamura,

Tanaka

et al. 2023

JCM

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Background: H2FPEF is a recently introduced score for the diagnosis of heart failure with preserved ejection fraction (HFpEF). Many patients with severe aortic stenosis have clinical/subclinical HFpEF and have worsening heart failure even after trans-catheter aortic valve replacement (TAVR). We investigated the prognostic impact of the H2FPEF score in TAVR candidates. Methods: Patients undergoing TAVR procedures at a single academic center between 2015 and 2022 were included. The H2FPEF score was calculated using baseline characteristics before TAVR. The prognostic impact of the score on the post-TAVR composite endpoint, consisting of all-cause death and heart failure readmissions during the 2-year observation period, was evaluated. Results: A total of 244 patients (median age 86 years, 70 males) were included. The median value of H2FPEF score was 3 (2, 4). The score was significantly associated with the primary outcome with a hazard ratio of 1.33 (95% confidence interval 1.02–1.74, p = 0.036). We constructed a modified H2FPEF score by adjusting cutoffs of several items for better prognostic stratification (i.e., age and body mass index). A modified score had a higher area under the curve than the original one (0.65 vs. 0.59, p = 0.028) and was independently associated with the primary outcome with an adjusted hazard ratio of 1.22 (95% confidence interval 1.01–1.49, p = 0.047). Conclusions: A modified H2FPEF score, which was originally developed to diagnose the presence of HFpEF, could be used to risk-stratify elderly patients receiving TAVR. The clinical utility of this score should be validated in future studies.

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“…Phenotypic differences may exist in HFpEF patients between Japan and other geographical regions. Therefore, careful characterization is needed to detect new therapies specific to the Japanese population [53]. Since the age of the subjects included in major papers [54,55] showing established results regarding the pharmacological interventions in patients with HFpEF was much younger than that in our study subjects [41], large-scale prospective studies are required to investigate the age-, sex-, follow-up duration-, and geographical region-related differences in the clinical significance of Ed/Ea for the prognosis of HFpEF patients with and without hospitalization.…”

Section: Futured Perspectivesmentioning

confidence: 99%

Due Diligence of a Diastolic Index as a Prognostic Factor in Heart Failure with Preserved Ejection Fraction

Hoshida

2023

JCM

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Of the existing non-invasive diastolic indices, none consider arterial load. This article reveals points of caution for determining the diastolic prognostic index using a novel index of vascular resistance-integrated diastolic function in old, real-world patients with heart failure with preserved ejection fraction (HFpEF) in Japan. This index represents the ratio of left ventricular diastolic elastance (Ed) to arterial elastance (Ea), where Ed/Ea = (E/e′)/(0.9 × systolic blood pressure), showing a relative ratio of left atrial filling pressure to left ventricular end-systolic pressure. The role of hemodynamic prognostic factors related to diastolic function, such as Ed/Ea, may differ according to the clinical endpoint, follow-up duration, and sex. In HFpEF patients with heterogenous cardiac structure and function, an assessment using a serial echocardiographic diastolic index in clinical care can provide an accurate prognosis.

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Epidemiology, Pathophysiology, Diagnosis, and Therapy of Heart Failure With Preserved Ejection Fraction in Japan

Cited by 20 publications

References 123 publications

How to Manage Beta-Blockade in Older Heart Failure Patients: A Scoping Review

How to Manage Beta-Blockade in Older Heart Failure Patients: A Scoping Review

Prognostic Impact of Modified H2FPEF Score in Patients Receiving Trans-Catheter Aortic Valve Replacement

Due Diligence of a Diastolic Index as a Prognostic Factor in Heart Failure with Preserved Ejection Fraction

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