Mortality in diastolic heart failure: an update.

In 2003, the prevalence of heart failure in the United States was 5 million persons. Although historically at least one-third of these patients were considered to have diastolic heart failure (DHF) or "heart failure with preserved ejection fraction," contemporary cohort studies have shown that the prevalence of DHF in the community is not only higher than previously thought, but is actually rising. The increasing prevalence of this disorder has been attributed, in part, to the increasing mean age of the population and a progressive increase in the prevalence of associated risk factors, such as hypertension, obesity, and diabetes mellitus. New data suggest that mortality from DHF is high, if not equivalent, to that of systolic heart failure. For example, 2 recent retrospective studies found that the for 1 year all-cause mortality after an admission for DHF was 22% and 29%. Additional results from the Cardiovascular Health Study suggest that despite marginal differences in mortality rates, DHF has a greater attributable mortality rate because there are greater numbers of patients with HF with normal ejection fraction. Several important conclusions should be drawn from these data. One, the prevalence of DHF is high and is increasing. Second, the associated mortality is high, and comparable to systolic heart failure. Finally, efforts to reduce the prevalence of risk factors for DHF should be redoubled, and prospective clinical trials should be designed to help us better understand the pathophysiology and treatment of this disorder.