Heart Failure With Preserved Ejection Fraction
Heart Failure With Preserved Ejection Fraction
Since multiple age-related co-morbidities may co-exist in patients with HFpEF, knowledge of cause-specific mortality is important to discern the risk related to the co-morbidity vs. the risk associated with HFpEF itself.
Numerous studies have now shown that the mortality burden of HFpEF is substantial, ranging from 10 to 30% annually, and is higher in epidemiologic studies than clinical trials. The pooled death rate in HFpEF was 121 [95% confidence interval (CI): 117, 126] deaths per 1000 patient-years in a meta-analysis of 31 studies. Mortality rates are clearly elevated compared with age- and co-morbidity-matched controls without HF, and may be as high as in HFrEF. The majority of deaths in HFpEF are CV deaths, 51–60% of deaths in epidemiologic studies, and ~70% in clinical trials. Among CV deaths, sudden death and HF death are the leading cardiac modes of death in HFpEF clinical trials. However, compared with HFrEF, the proportions of CV deaths, sudden death and HF deaths are lower and conversely, non-cardiovascular death is higher in HFpEF.
A greater non-cardiac co-morbidity burden in HFpEF offers a potentially simple explanation for the mortality differences between epidemiologic studies and clinical trials, or between HFpEF and HFrEF. However, the extent to which non-cardiac co-morbidities predict death in HFpEF remains unclear, and non-cardiac co-morbidities alone do not explain mortality differences between different HF cohorts. The extent of coronary artery disease appears to be inversely related to non-cardiovascular deaths in both the Olmsted County community-based cohort and in the clinical trial population from TIME-CHF. A potential explanation for these observations is that patients with HFpEF 'escape' death related to coronary artery disease and subsequently die from their non-cardiac co-morbidities. Alternatively, patients with coronary artery disease may have been more likely to 'transition' to HFrEF following a myocardial infarction, thus enriching the HFrEF population with more coronary heart deaths.
How Do Patients With Heart Failure With Preserved Ejection Fraction Die?
Since multiple age-related co-morbidities may co-exist in patients with HFpEF, knowledge of cause-specific mortality is important to discern the risk related to the co-morbidity vs. the risk associated with HFpEF itself.
Numerous studies have now shown that the mortality burden of HFpEF is substantial, ranging from 10 to 30% annually, and is higher in epidemiologic studies than clinical trials. The pooled death rate in HFpEF was 121 [95% confidence interval (CI): 117, 126] deaths per 1000 patient-years in a meta-analysis of 31 studies. Mortality rates are clearly elevated compared with age- and co-morbidity-matched controls without HF, and may be as high as in HFrEF. The majority of deaths in HFpEF are CV deaths, 51–60% of deaths in epidemiologic studies, and ~70% in clinical trials. Among CV deaths, sudden death and HF death are the leading cardiac modes of death in HFpEF clinical trials. However, compared with HFrEF, the proportions of CV deaths, sudden death and HF deaths are lower and conversely, non-cardiovascular death is higher in HFpEF.
A greater non-cardiac co-morbidity burden in HFpEF offers a potentially simple explanation for the mortality differences between epidemiologic studies and clinical trials, or between HFpEF and HFrEF. However, the extent to which non-cardiac co-morbidities predict death in HFpEF remains unclear, and non-cardiac co-morbidities alone do not explain mortality differences between different HF cohorts. The extent of coronary artery disease appears to be inversely related to non-cardiovascular deaths in both the Olmsted County community-based cohort and in the clinical trial population from TIME-CHF. A potential explanation for these observations is that patients with HFpEF 'escape' death related to coronary artery disease and subsequently die from their non-cardiac co-morbidities. Alternatively, patients with coronary artery disease may have been more likely to 'transition' to HFrEF following a myocardial infarction, thus enriching the HFrEF population with more coronary heart deaths.