Predicting Heart Failure With Preserved and Reduced Ejection Fraction

Abstract

Background Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF subtypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fraction (HFpEF, HFrEF). Methods and Results Of 28,820 participants from four community-based cohorts, 982 developed incident HFpEF and 909 HFrEF during a median follow-up of 12 years. Three cohorts were combined and a 2:1 random split used for derivation and internal validation, with the fourth cohort as external validation. Models accounted for multiple competing risks (death, other HF subtype, unclassified HF). The HFpEF-specific model included age, sex, systolic blood pressure, body mass index, antihypertensive treatment, and prior myocardial infarction; it had good discrimination in derivation (c-statistic 0.80, 95% CI 0.78–0.82) and validation samples (internal 0.79, 95% CI 0.77–0.82; external 0.76, 95% CI 0.71–0.80). The HFrEF-specific model additionally included smoking, left ventricular hypertrophy (LVH), left bundle branch block (LBBB), and diabetes; it had good discrimination in derivation (c-statistic 0.82, 95% CI 0.80–0.84) and validation samples (internal 0.80, 95% CI 0.78–0.83; external 0.76, 95% CI 0.71–0.80). Age was more strongly associated with HFpEF, and male sex, LVH, LBBB, prior myocardial infarction, and smoking with HFrEF (P for each comparison ≤ 0.02). Conclusions We describe and validate risk prediction models for HF subtypes, and show good discrimination in a large sample. Some risk factors differed between HFpEF and HFrEF, supporting the notion of pathogenetic differences among HF subtypes.

Poor acute outcome in congestive heart failure is associated with increases in the plasma static oxidation–reduction potentials (sORP) in men but not in women

“…The differences in baseline characteristics between the male and female patients of this study are also similar to what has been previously reported in the literature for higher diastolic blood pressure (dBP), hematocrit levels, ejection fraction, and diabetes [10,[19][20][21]. There have also been reports that biomarkers, such as BNP, have a sexual bias in predicting cardiac outcome.…”

“…Compared to females, heart failure in males has been associated with lower ejection fraction and slower heart rate; males may also have elevated levels of brain natriuretic peptide (BNP), higher creatinine and galectin-3 levels, higher diastolic blood pressure (dBP), and are more likely to be diabetic [11,[20][21][22]. Thus, in light of the paucity of information regarding sex differences, oxidative stress, and CHF, we conducted a study with the purpose of measuring a global biomarker of oxidative stress in both sexes hospitalized for CHF to determine if oxidative stress is differentially expressed in males and females under these conditions and if there is a difference based on acute outcome.…”

Diastolic Blood Pressure and Adverse Outcomes in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial

“…HFpEF represents a complex clinical syndrome with multiple comorbidities, such as hypertension, diabetes mellitus, renal disease, metabolic syndrome, and atrial fibrillation . Systemic hypertension is the most prevalent modifiable risk factor, and its presence confers an increased risk of developing clinically apparent heart failure …”

Race/Ethnic Differences in Outcomes Among Hospitalized Medicare Patients With Heart Failure and Preserved Ejection Fraction

“…With respect to comorbidities, black and Hispanic patients had higher rates of diabetes, hypertension, and renal insufficiency. These findings suggest that the known risk factors for HFpEF are more prevalent among minority patients (5,6). These differences in comorbidities according to race/ethnicity among patients with HFpEF is consistent with the observed trends in cardiovascular risk factors among minorities nationally, in which the prevalence of obesity, poorly controlled hypertension, and diabetes has increased (10).…”

“…Hypertension is the strongest known risk factor for HFpEF, along with age, obesity, and diabetes mellitus (5,6). Among hospitalized Medicare patients with HF, those with HFpEF have an observed lower mortality but higher readmission rate compared with those with HFrEF (7).…”