Carolyn S P Lam1,2, Greg D Gamble3, Lieng H Ling1,2, David Sim2, Kui Toh Gerard Leong4, Poh Shuan Daniel Yeo5, Hean Yee Ong6, Fazlur Jaufeerally7, Tze P Ng8, Vicky A Cameron9, Katrina Poppe3, Mayanna Lund10, Gerry Devlin11, Richard Troughton9, A Mark Richards1,8,9, Robert N Doughty3. 1. Cardiovascular Research Institute, National University Health System, 1E Kent Ridge Road, Singapore 119228. 2. National Heart Centre Singapore and Duke-National University of Singapore, 5 Hospital Drive, Singapore 169609. 3. Heart Health Research Group, University of Auckland, Park Road, Grafton, Auckland 1023, New Zealand. 4. Changi General Hospital, 2 Simei Street 3, Singapore 529889. 5. Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. 6. Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828. 7. Singapore General Hospital, Outram Road, Singapore 169608. 8. Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road Singapore, Singapore 119228. 9. Christchurch Heart Institute, University of Otago, 2 Riccarton Avenue, Christchurch 8011, New Zealand. 10. Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland 2025, NZ. 11. Waikato Hospital, Pembroke Street, Hamilton 3204, New Zealand.
Abstract
Aims: Whether prevalence and mortality of patients with heart failure with preserved or mid-range (40-49%) ejection fraction (HFpEF and HFmREF) are similar to those of heart failure with reduced ejection fraction (HFrEF), as reported in some epidemiologic studies, remains highly controversial. We determined and compared characteristics and outcomes for patients with HFpEF, HFmREF, and HFrEF in a prospective, international, multi-ethnic population. Methods and results: Prospective multi-centre longitudinal study in New Zealand (NZ) and Singapore. Patients with HF were assessed at baseline and followed over 2 years. The primary outcome was death from any cause. Secondary outcome was death and HF hospitalization. Cox proportional hazards models were used to compare outcomes for patients with HFpEF, HFmrEF, and HFrEF. Of 2039 patients enrolled, 28% had HFpEF, 13% HFmrEF, and 59% HFrEF. Compared with HFrEF, patients with HFpEF were older (62 vs. 72 years), more commonly female (17% vs. 48%), and more likely to have a history of hypertension (61% vs. 78%) but less likely to have coronary artery disease (55% vs. 41%). During 2 years of follow-up, 343 (17%) patients died. Adjusting for age, sex, and clinical risk factors, patients with HFpEF had a lower risk of death compared with those with HFrEF (hazard ratio 0.62, 95% confidence interval 0.46-0.85). Plasma (NT-proBNP) was similarly related to mortality in both HFpEF, HFmrEF, and HFrEF independent of the co-variates listed and of ejection fraction. Results were similar for the composite endpoint of death or HF and were consistent between Singapore and NZ. Conclusion: These prospective multinational data showed that the prevalence of HFpEF within the HF population was lower than HFrEF. Death rate was comparable in HFpEF and HFmrEF and lower than in HFrEF. Plasma levels of NT-proBNP were independently and similarly predictive of death in the three HF phenotypes. Trial Registration: Australian New Zealand Clinical Trial Registry (ACTRN12610000374066).
Aims: Whether prevalence and mortality of patients with heart failure with preserved or mid-range (40-49%) ejection fraction (HFpEF and HFmREF) are similar to those of heart failure with reduced ejection fraction (HFrEF), as reported in some epidemiologic studies, remains highly controversial. We determined and compared characteristics and outcomes for patients with HFpEF, HFmREF, and HFrEF in a prospective, international, multi-ethnic population. Methods and results: Prospective multi-centre longitudinal study in New Zealand (NZ) and Singapore. Patients with HF were assessed at baseline and followed over 2 years. The primary outcome was death from any cause. Secondary outcome was death and HF hospitalization. Cox proportional hazards models were used to compare outcomes for patients with HFpEF, HFmrEF, and HFrEF. Of 2039 patients enrolled, 28% had HFpEF, 13% HFmrEF, and 59% HFrEF. Compared with HFrEF, patients with HFpEF were older (62 vs. 72 years), more commonly female (17% vs. 48%), and more likely to have a history of hypertension (61% vs. 78%) but less likely to have coronary artery disease (55% vs. 41%). During 2 years of follow-up, 343 (17%) patientsdied. Adjusting for age, sex, and clinical risk factors, patients with HFpEF had a lower risk of death compared with those with HFrEF (hazard ratio 0.62, 95% confidence interval 0.46-0.85). Plasma (NT-proBNP) was similarly related to mortality in both HFpEF, HFmrEF, and HFrEF independent of the co-variates listed and of ejection fraction. Results were similar for the composite endpoint of death or HF and were consistent between Singapore and NZ. Conclusion: These prospective multinational data showed that the prevalence of HFpEF within the HF population was lower than HFrEF. Death rate was comparable in HFpEF and HFmrEF and lower than in HFrEF. Plasma levels of NT-proBNP were independently and similarly predictive of death in the three HF phenotypes. Trial Registration: Australian New Zealand Clinical Trial Registry (ACTRN12610000374066).
Authors: Julio A Chirinos; Alena Orlenko; Lei Zhao; Michael D Basso; Mary Ellen Cvijic; Zhuyin Li; Thomas E Spires; Melissa Yarde; Zhaoqing Wang; Dietmar A Seiffert; Stuart Prenner; Payman Zamani; Priyanka Bhattacharya; Anupam Kumar; Kenneth B Margulies; Bruce D Car; David A Gordon; Jason H Moore; Thomas P Cappola Journal: J Am Coll Cardiol Date: 2020-03-24 Impact factor: 24.094
Authors: Julio A Chirinos; Lei Zhao; Yi Jia; Cecilia Frej; Luigi Adamo; Douglas Mann; Swapnil V Shewale; John S Millar; Daniel J Rader; Benjamin French; Jeff Brandimarto; Kenneth B Margulies; John S Parks; Zhaoqing Wang; Dietmar A Seiffert; James Fang; Nancy Sweitzer; Christina Chistoffersen; Björn Dahlbäck; Bruce D Car; David A Gordon; Thomas P Cappola; Ali Javaheri Journal: Circulation Date: 2020-04-02 Impact factor: 29.690