Noncardiac Comorbidities in Heart Failure With Reduced Versus Preserved Ejection Fraction

Abstract

Heart failure patients are classified by ejection fraction (EF) into distinct groups: heart failure with preserved EF (HFpEF) or heart failure with reduced EF (HFrEF). Although patients with heart failure commonly have multiple comorbidities that complicate management and may adversely affect outcomes, their role in the HFpEF and HFrEF groups is not well-characterized. This review summarizes the role of noncardiac comorbidities in patients with HFpEF versus HFrEF, emphasizing prevalence, underlying pathophysiologic mechanisms, and outcomes. Pulmonary disease, diabetes mellitus, anemia, and obesity tend to be more prevalent in HFpEF patients, but renal disease and sleep-disordered breathing burdens are similar. These comorbidities similarly increase morbidity and mortality risk in HFpEF and HFrEF patients. Common pathophysiologic mechanisms include systemic and endomyocardial inflammation with fibrosis. We also discuss implications for clinical care and future HF clinical trial design. The basis for this review was discussions between scientists, clinical trialists, and regulatory representatives at the 10th Global CardioVascular Clinical Trialists Forum.

Sex‐ and Race‐Related Differences in Characteristics and Outcomes of Hospitalizations for Heart Failure With Preserved Ejection Fraction

“…After adjusting for the Elixhauser score, sex‐related differences in mortality were attenuated, extending observations from smaller studies derived from the Get With the Guidelines—Heart Failure27 and Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE‐EM) databases,6 that in‐hospital mortality is comparable between sexes. Given its observed influence on in‐hospital mortality, our study builds on prior data by demonstrating the potential utility of the Elixhauser score in risk‐stratifying hospitalized patients with HFpEF, further highlighting the importance of comorbidity on outcomes within the HFpEF population 28, 29, 30…”

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…The overall prevalence of COPD in HFpEF is 30% 208. When present, COPD is an independent predictor of mortality 238.…”

“…Renal dysfunction is common in HFpEF patients and especially prevalent in elderly obese/diabetic patients with hypertension 208, 285. Overall, renal dysfunction is present in 30% to 60% of patients with HFpEF 208, 286, 287.…”

“…Overall, renal dysfunction is present in 30% to 60% of patients with HFpEF 208, 286, 287. The prevalence of renal dysfunction is greater when defined by estimated glomerular filtration rate (eGFR) <60 mL/min/m 2 and high urinary albumin creatinine ratio than by eGFR alone 288.…”

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

“…Since HF-PEF patients are generally at advanced age, almost every patient has at least one accompanying disease and most of them have multiple co-morbidities ( Figure 5) (245,246). These diseases are important as they have to be considered in the differential diagnosis of HF-PEF, increase mortality and morbidity of HF, interfere with the treatment, and cause recurrent hospitalizations if diagnosis cannot be established (247).…”