Prognostic impact of Framingham heart failure criteria in heart failure with preserved ejection fraction

Abstract

Aims This study aims to assess prognostic impact of Framingham criteria for heart failure (FC‐HF) in patients with stable heart failure (HF) with preserved ejection fraction (HFpEF). Methods and results In the prospective Karolinska‐Rennes (KaRen) study, we assessed stable HFpEF patients after an acute HF episode. We evaluated associations between the four descriptive models of HFpEF and the composite endpoint of all‐cause mortality and HF hospitalization. The descriptive models were FC‐HF alone, FC‐HF + natriuretic peptides (NPs) according to the PARAGON trial, FC‐HF + NPs + echocardiographic HFpEF criteria according to European Society of Cardiology HF guidelines, and FC‐HF + NPs + echocardiographic criteria according to the PARAGON trial. Out of the 539 patients enrolled in KaRen, 438 returned for the stable state revisit after 4–8 weeks, 13 (2.4%) patients died before the planned follow‐up, and 88 patients (16%) declined or were unable to return. Three hundred ninety‐nine patients have FC registered at follow‐up, and among these, the four descriptive models were met in 107 (27%), 82 (22%), 61 (21%), and 69 (22%) patients, and not met in 292 (73%). The 107 patients that had FC‐HF at stable state (descriptive model 1) could also be part of the other models because all patients in models 1–4 had to fulfil the FC‐HF. The patients in model 0 did not fulfil the criteria for FC‐HF but could have single FC. Of single FC, only pleural effusion predicted the endpoint [hazard ratio (HR) 3.38, 95% confidence interval (CI) 1.47–7.76, P = 0.004]. Patients without FC‐HF had better prognosis than patients meeting FC‐HF. The unadjusted associations between the four HFpEF descriptive models and the endpoint were HR 1.54, 95% CI 1.14–2.09, P = 0.005; HR 1.71, 95% CI 1.24–2.36, P = 0.002; HR 1.95, 95% CI 1.36–2.81, P = 0.001; and HR 2.05, 95% CI 1.45–2.91, P < 0.001, for descriptive models 1–4, respectively. No descriptive model independently predicted the endpoint. Conclusions In ambulatory HFpEF patients, a quarter met FC‐HF, while most met NP and echocardiography criteria for HF. Residual FC‐HF tended to be associated with increased risk for mortality and HF hospitalization, further strengthened by NPs and echocardiographic criteria, highlighting its role in clinical risk assessment.

Sympathetic Neural Control at Rest and During the Cold Pressor Test in Patients With Heart Failure With Preserved Ejection Fraction

“…Twenty-eight patients with HFpEF and 44 control participants matched for age, sex, race, and resting BP participated in this study. Patients with HFpEF were eligible to participate if they were older than 55 years, had signs and symptoms of HF based on Framingham criteria 17 with objective evidence of congestion including chest X-ray, elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide; >900 pg/mL) or filling pressures (pulmonary capillary wedge pressure of ≥25 mm Hg at peak exercise or an increase in pulmonary capillary wedge pressure ≥15 mm Hg from rest to peak exercise), left ventricular ejection fraction ≥50%, and had sinus rhythm during laboratory measurement either with or without AFib. To confirm the inclusion criteria for HFpEF, 26 patients performed the screening test within 2 months, and 2 patients performed it within 5 and 8 months before the laboratory test.…”

Prevalence of depression and its association with health-related quality of life in people with heart failure in low- and middle-income countries: A systematic review and meta-analysis

“…The prevalence of depression and/or association of depression with HRQoL in the participants. For the purpose of this review, heart failure is defined as the inability of the heart to effectively pump blood as evidenced by either signs and symptoms based on Framingham criteria or reduced ejection fraction (<40%) [ 19 , 20 ]. Depression is defined as the persistent feeling of unhappiness and lack of interest in daily activities with symptoms for at least two weeks, based on DSM-5 diagnostic criteria [ 21 ].…”

Nonmalignant Pleural Effusions

“…69 A prospective study of 399 patients with stable HF and preserved ejection fraction pointed to pleural effusion as the only Framingham criteria which predicted the composite end point of all-cause mortality and HF hospitalization (hazard ratio [HR] = 3.38). 70 In a large American database, thoracentesis was deemed to be necessary in just 3.14% of more than 2.2 million hospitalizations for HF. 71 When 70,823 inpatients who underwent thoracentesis were matched with a similar number of HF patients who did not undergo thoracentesis, the former group exhibited a higher in-hospital mortality rate (2.5 vs. 1.6%), hospitalization costs ($13,448 vs. 8,940), and a longer mean length of stay (6.9 vs. 4.5 days).…”