Muthiah Vaduganathan1, Alexander Michel2, Kathryn Hall3, Claire Mulligan3, Savina Nodari4, Sanjiv J Shah5, Michele Senni6, Marco Triggiani4, Javed Butler7, Mihai Gheorghiade5. 1. Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA. 2. Bayer Pharma AG, Global Epidemiology, Berlin, Germany. 3. Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK. 4. Department of Experimental and Applied Medicine - Section of Cardiovascular Diseases, University of Brescia, Brescia, Italy. 5. Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, 201 East Huron, Galter 3-150, Chicago, IL, USA. 6. Dipartimento Cardiovascolare, Azienda Ospedaliera Papa Giovannni XXIII, Bergamo, Italy. 7. Division of Cardiology, Stony Brook University, Stony Brook, NY, USA.
Abstract
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) represents a major global and economic burden, but its epidemiological, clinical, and outcome data have varied according to study design. METHODS AND RESULTS: We conducted a systematic review of published HFpEF clinical trials and observational studies (community-based studies and registries) from August 1998 to July 2013 using PubMed and EMBASE databases. Two independent investigators manually screened and extracted relevant data. We included 62 articles (19 describing clinical trials, 12 describing community-based observational studies, and 31 describing registries). The ejection fraction (EF) cut-off values ranged widely for HFpEF from >40% to >55%. However, differences in EF cut-offs were not clearly associated with incidence and prevalence data across studies. Of all patients with heart failure in community studies, 33-84% had HFpEF, which tended to be higher than reported in registries. The HFpEF patients in included studies were primarily older, white (>70%) patients with hypertension (∼50-90%) and coronary artery disease (up to 60%). All-cause mortality and all-cause hospitalizations ranged from 13% to 23% (26-50 months follow-up) and 55% to 67% (37-50 months follow-up), respectively, in clinical trials; cardiovascular causes accounted for 70% of both outcomes. All-cause mortality tended to be higher in registries than in clinical trials and community-based observational studies up to 5 years into follow-up. CONCLUSIONS: Important differences in EF thresholds, epidemiological indices, clinical profiles, treatment patterns, and outcomes exist across contemporary HFpEF clinical trials, observational studies, and registries. Precision in definition and inclusion of more uniform populations may facilitate improved profiling of HFpEF patients.
BACKGROUND:Heart failure with preserved ejection fraction (HFpEF) represents a major global and economic burden, but its epidemiological, clinical, and outcome data have varied according to study design. METHODS AND RESULTS: We conducted a systematic review of published HFpEF clinical trials and observational studies (community-based studies and registries) from August 1998 to July 2013 using PubMed and EMBASE databases. Two independent investigators manually screened and extracted relevant data. We included 62 articles (19 describing clinical trials, 12 describing community-based observational studies, and 31 describing registries). The ejection fraction (EF) cut-off values ranged widely for HFpEF from >40% to >55%. However, differences in EF cut-offs were not clearly associated with incidence and prevalence data across studies. Of all patients with heart failure in community studies, 33-84% had HFpEF, which tended to be higher than reported in registries. The HFpEF patients in included studies were primarily older, white (>70%) patients with hypertension (∼50-90%) and coronary artery disease (up to 60%). All-cause mortality and all-cause hospitalizations ranged from 13% to 23% (26-50 months follow-up) and 55% to 67% (37-50 months follow-up), respectively, in clinical trials; cardiovascular causes accounted for 70% of both outcomes. All-cause mortality tended to be higher in registries than in clinical trials and community-based observational studies up to 5 years into follow-up. CONCLUSIONS: Important differences in EF thresholds, epidemiological indices, clinical profiles, treatment patterns, and outcomes exist across contemporary HFpEF clinical trials, observational studies, and registries. Precision in definition and inclusion of more uniform populations may facilitate improved profiling of HFpEF patients.
Authors: Oliver Riedel; C Ohlmeier; D Enders; A Elsässer; D Vizcaya; A Michel; S Eberhard; N Schlothauer; J Berg; E Garbe Journal: Clin Res Cardiol Date: 2018-02-05 Impact factor: 5.460
Authors: Priyesh A Patel; Andrew P Ambrosy; Matthew Phelan; Fawaz Alenezi; Karen Chiswell; Melissa K Van Dyke; Jennifer Tomfohr; Narimon Honarpour; Eric J Velazquez Journal: Eur J Heart Fail Date: 2019-12-21 Impact factor: 15.534