Epidemiology and pathogenesis of heart failure with preserved ejection fraction.
Level 5 - mechanism / opinion, no new human data
Narrative review of epidemiology and pathophysiology without systematic review methodology
PubMed 33387998 · doi:10.31083/j.rcm.2020.04.154
What was done
This narrative review synthesized literature on the epidemiology, risk factors, and cellular pathophysiology of heart failure with preserved ejection fraction (HFpEF).
What was found
Heart failure affects roughly 6.5 million adults in the United States, with approximately 50% having HFpEF. The reported proportion of HFpEF among heart failure cases rose from 48% in 2000 to 57% in 2007, before shifting to 52% in 2010, amid overall stable heart failure incidence marked by increasing HFpEF and decreasing HFrEF. Pathophysiologic mechanisms described include inflammation, endothelial dysfunction, cardiomyocyte hypertrophy, ventricular-vascular uncoupling, pulmonary hypertension, chronotropic incompetence, upregulated reactive oxygen species (ROS), and apoptosis-resistant fibroblasts that drive abnormal myocardial matrix deposition and fibrosis.
Why it matters
Understanding the distinct cellular and structural mechanisms of HFpEF—particularly matrix remodeling driven by apoptosis-resistant fibroblasts—identifies specific pathways for targeted therapies in a growing patient population with limited effective interventions.
Limits
As a narrative review, the paper does not use a systematic literature search, formal risk-of-bias assessment, or meta-analytic pooling. The abstract reports secondary epidemiological figures without confidence intervals or primary cohort details.
Cited by
- supports Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of all heart failure cases.