Outcome of Heart Failure with Preserved Ejection Fraction in a Population-Based Study

Bhatia, R. Sacha; Tu, Jack V.; Lee, Douglas S.; Austin, Peter C.; Fang, Jiming; Haouzi, Annick; Gong, Yanjun; Liu, Peter P.

doi:10.1056/nejmoa051530

Cited by 1,741 publications

(1,402 citation statements)

References 32 publications

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“…Discrepancies between the current findings and the previous literature with regard to variables affecting the long‐term prognosis of patients with ADHF could be related to a number of factors including comparatively small numbers of women studied, use of clinical trial data, different HF diagnostic criteria, exclusion of patients with BpEF,11 duration of follow‐up, and specific EF strata used. Future studies should use the same EF strata as those proposed in the 2013 AHA/ACC guidelines2 to ensure that studies can be adequately compared.…”

Section: Discussioncontrasting

confidence: 83%

“…There have been conflicting published findings as to which EF strata have better long‐term prognosis after patients develop ADHF 11, 13, 14, 15, 16, 17. In the present study, patients with pEF fared better over long‐term follow‐up than patients with either rEF or BpEF up to 2004.…”

Section: Discussioncontrasting

confidence: 51%

“…Prospective studies that have classified patients with HF into groups based on EF findings and examined predictors of mortality have typically assessed only 2 strata, namely, those with pEF and rEF findings 11, 13, 14, 15, 16, 17. Consistent with the previous literature, older age was associated with worse prognosis for patients across EF strata.…”

Section: Discussionmentioning

confidence: 64%

“…Prior epidemiological studies have identified a number of important prognostic factors associated with poor long‐term outcomes for patients with ADHF including advanced age, male sex, hyponatremia, lower systolic blood pressure, poorer kidney function, and several comorbid conditions 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Many of these earlier studies examined the role of various prognostic factors in patients with HF that had not further been stratified according to EF findings, and among those that did,11, 13, 14, 15, 16, 17 none used the 2013 AHA/ACC guidelines recommending specific EF cut points 2.…”

Section: Introductionmentioning

confidence: 99%

“…Many of these earlier studies examined the role of various prognostic factors in patients with HF that had not further been stratified according to EF findings, and among those that did,11, 13, 14, 15, 16, 17 none used the 2013 AHA/ACC guidelines recommending specific EF cut points 2. Furthermore, few data exist on the prognosis or the factors associated with poor long‐term prognosis for patients with BpEF values, especially from the more generalizable perspective of a population‐based investigation.…”

Section: Introductionmentioning

confidence: 99%

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Magnitude of and Prognostic Factors Associated With 1‐Year Mortality After Hospital Discharge for Acute Decompensated Heart Failure Based on Ejection Fraction Findings

Coles

Tisminetzky

Yarzebski

et al. 2015

JAHA

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BackgroundLimited data exist about the magnitude of and the factors associated with prognosis within 1 year for patients discharged from the hospital after acute decompensated heart failure. Data are particularly limited from the more generalizable perspective of a population‐based investigation and should be further stratified according to currently recommended ejection fraction (EF) findings.Methods and ResultsThe hospital medical records of residents of the Worcester, Massachusetts, metropolitan area who were discharged after acute decompensated heart failure from all 11 medical centers in central Massachusetts during 1995, 2000, 2002, 2004, and 2006 were reviewed. The average age of the 4025 study patients was 75 years, 93% were white, and 44% were men. Of these, 35% (n=1414) had reduced EF (≤40%), 13% (n=521) had borderline preserved EF (41–49%), and 52% (n=2090) had preserved EF (≥50%); at 1 year after discharge, death rates were 34%, 30%, and 29%, respectively (P=0.03). Older age, a history of chronic obstructive pulmonary disease, systolic blood pressure findings <150 mm Hg on admission, and hyponatremia were important predictors of 1‐year mortality for all study patients, whereas several comorbidities and physiological factors were differentially associated with 1‐year death rates in patients with reduced, borderline preserved, and preserved EF.ConclusionsThis population‐based study highlights the need for further contemporary research into the characteristics, treatment practices, natural history, and long‐term outcomes of patients with acute decompensated heart failure and varying EF findings and reinforces ongoing discussions about whether different treatment guidelines may be needed for these patients to design more personalized treatment plans.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Magnitude of and Prognostic Factors Associated With 1‐Year Mortality After Hospital Discharge for Acute Decompensated Heart Failure Based on Ejection Fraction Findings

Coles

Tisminetzky

Yarzebski

et al. 2015

JAHA

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BNP-Guided vs Symptom-Guided Heart Failure Therapy

Pfisterer¹,

Buser²,

Rickli³

et al. 2009

JAMA

552

161

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guided by N-terminal brain natriuretic peptide (BNP) has been proposed to improve outcome compared with conventional therapy in patients with chronic heart failure in some studies. [1][2][3][4] However, these studies were small (n = 69, 1 n = 220, 2 n=130 3 ), not conclusive, 3,4 had limited follow-up, focused on younger patients, 2,3 and/or have not yet been published in detail. 3,4 The concept of an intensified N-terminal BNP-guided therapy might be particularly attractive in older patients who are less physically active and in whom symptoms are less reliable, but they also may be more susceptible to drug-related adverse effects. Problems of heart failure increase with age. 5 Heart failure is the most common reason for hospitalization in patients aged 65 years or older. 6 Older patients are underrepresented in randomized controlled trials, 7 mainly be-For editorial comment see p 432.

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Progression of Left Ventricular Diastolic Dysfunction and Risk of Heart Failure

Kane¹,

Karon²,

Mahoney³

et al. 2011

JAMA

562

440

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Context Heart failure increases with advancing age, and approximately half of patients have preserved left ventricular ejection fraction. Although diastolic dysfunction plays a role in heart failure with preserved ejection fraction, little is known about age-dependent longitudinal changes in diastolic function in community populations. Objective To measure longitudinal change in diastolic function and heart failure incidence in a population-based cohort. Design 2042 randomly selected participants underwent clinical evaluation, medical record abstraction, and echocardiography (1997–2000). Diastolic left ventricular function was graded as mild, moderate, or severe by validated Doppler techniques. After four years participants were invited to return for re-examination, and 1402 did so (2001–2004). The cohort was then followed for ascertainment of new onset heart failure (2004–2010). Setting Community population; Olmsted County, Minnesota Participants Population-based cohort of persons ≥45 years old Main Outcome Measures Incident heart failure Results Over 4 ± 0.3 years diastolic dysfunction prevalence increased from 23.8% (95% CI 21.2–26.4) to 39.2% (95% CI 36.3–42.2) (P <0.001). Diastolic function grade worsened in 23.4% (95% CI 20.9–26.0) of participants, was unchanged in 67.8% (95% CI 64.9–70.6), and improved in 8.8% (95% CI 7.1–10.5). Worsened diastolic dysfunction was associated with age ≥65 years (OR 2.85; 95% CI 1.77–4.72). During 6.3 ± 2.3 years of additional follow-up, heart failure occurred in 2.6% (95% CI 1.4–3.8), 7.8% (95% CI 5.8–13.0), and 12.2% (95% CI 8.5–18.4) of persons whose diastolic function normalized or remained normal, remained or progressed to mild dysfunction, or remained or progressed to moderate-severe dysfunction, respectively. (P <0.001) Diastolic dysfunction was associated with incident heart failure after adjustment for age, hypertension, diabetes, and coronary disease (HR 1.81; 95% CI 1.01–3.48). Conclusion In a population-based cohort followed for four years, diastolic dysfunction prevalence increased. Diastolic dysfunction was associated with development of heart failure during six years of subsequent follow-up.

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Outcome of Heart Failure with Preserved Ejection Fraction in a Population-Based Study

Abstract: Among patients presenting with new-onset heart failure, a substantial proportion had an ejection fraction of more than 50 percent. The survival of patients with heart failure with preserved ejection fraction was similar to that of patients with reduced ejection fraction.

Cited by 1,741 publications

References 32 publications

Magnitude of and Prognostic Factors Associated With 1‐Year Mortality After Hospital Discharge for Acute Decompensated Heart Failure Based on Ejection Fraction Findings

Magnitude of and Prognostic Factors Associated With 1‐Year Mortality After Hospital Discharge for Acute Decompensated Heart Failure Based on Ejection Fraction Findings

BNP-Guided vs Symptom-Guided Heart Failure Therapy

Progression of Left Ventricular Diastolic Dysfunction and Risk of Heart Failure

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