Trends in prevalence and outcome of heart failure with preserved ejection fraction.
Level 3 - non-randomized controlled study
Retrospective cohort study of secular trends in hospitalized patients over a 15-year period
PubMed 16855265 · doi:10.1056/NEJMoa052256
What was done
Researchers analyzed consecutive patients hospitalized with decompensated heart failure at Mayo Clinic Hospitals in Olmsted County, Minnesota, between 1987 and 2001. Patients were categorized by ejection fraction (preserved vs. reduced) and patient origin (community residents vs. referral patients). The study assessed 15-year secular trends in heart failure subtype prevalence, comorbidities, and survival.
What was found
Among 6,076 total heart failure discharges, ejection fraction data were documented in 4,596 patients (76%). Of these, 53% had reduced ejection fraction and 47% had preserved ejection fraction. The proportion of patients with preserved ejection fraction increased over time and was higher among community patients than referral patients (55% vs. 45%). Comorbidities (hypertension, atrial fibrillation, and diabetes) increased significantly over time. Overall survival was slightly higher for preserved vs. reduced ejection fraction (adjusted hazard ratio for death, 0.96; P=0.01). Survival significantly improved over time for patients with reduced ejection fraction, but survival for patients with preserved ejection fraction remained unchanged.
Why it matters
This study demonstrated that heart failure with preserved ejection fraction constitutes nearly half of heart failure admissions and is rising in frequency. Unlike heart failure with reduced ejection fraction, clinical outcomes for preserved ejection fraction did not improve over a 15-year period.
Limits
The study was conducted at a single health system in one geographical region, limiting generalizability to more diverse populations. Ejection fraction measurements were missing in 24% (1,480 of 6,076) of patients. The abstract does not report specific medication treatments, outpatient cases, or cause-specific mortality.
Cited by
- supports Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of all heart failure cases.