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Comparing New Onset Heart Failure with Reduced Ejection Fraction and New Onset Heart Failure with Preserved Ejection Fraction: An Epidemiologic Perspective

  • Epidemiology of Heart Failure (J Butler, Section Editor)
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Abstract

The incidence and prevalence of heart failure is increasing, especially heart failure with preserved ejection fraction (HFpEF) relative to heart failure with reduced ejection fraction (HFrEF). For both HFrEF and HFpEF, there is need to shift our focus from secondary to primary prevention. Detailed epidemiologic data on both HFpEF and HFrEF are needed to allow early identification of at-risk subjects. Current cohorts with new onset heart failure lack uniformity with respect to diagnosis, follow-up, and population characteristics, but most important, fail to distinguish between HFpEF and HFrEF. Studies on prevalent heart failure show ischemic heart disease as the predominant risk factor for HFrEF, while hypertension, atrial fibrillation, and diabetes are risk factors for HFpEF. As it becomes increasingly clear that both subtypes of heart failure are different syndromes, new cohorts and trials are necessary to obtain separate data on both subtypes of heart failure.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of outstanding importance

  1. Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93(9):1137–46.

    Article  PubMed  Google Scholar 

  2. Owan TE, Redfield MM. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis. 2005;47(5):320–32.

    Article  PubMed  Google Scholar 

  3. Cheng S, Vasan RS. Advances in the epidemiology of heart failure and left ventricular remodeling. Circulation. 2011;124(20):e516–9.

    Article  PubMed  Google Scholar 

  4. Lam CS, Donal E, Kraigher-Krainer E, Vasan RS. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail. 2011;13(1):18–28.

    Article  PubMed  Google Scholar 

  5. Shin JJ, Hamad E, Murthy S, Pina IL. Heart failure in women. Clin Cardiol. 2012;35(3):172–7.

    Article  PubMed  Google Scholar 

  6. Heiat A, Gross CP, Krumholz HM. Representation of the elderly, women, and minorities in heart failure clinical trials. Arch Intern Med. 2002;162(15):1682–8.

    Article  PubMed  Google Scholar 

  7. McMurray JJ, Petrie MC, Murdoch DR, Davie AP. Clinical epidemiology of heart failure: public and private health burden. Eur Heart J. 1998;19(Suppl P):P9–16.

    PubMed  Google Scholar 

  8. Dhingra R, Vasan RS. Diabetes and the risk of heart failure. Heart Fail Clin. 2012;8(1):125–33.

    Article  PubMed  Google Scholar 

  9. Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347(5):305–13.

    Article  PubMed  Google Scholar 

  10. O'Connell JB. The economic burden of heart failure. Clin Cardiol. 2000;23(3 Suppl):III6–10.

    Article  PubMed  Google Scholar 

  11. Fang J, Mensah GA, Croft JB, Keenan NL. Heart failure-related hospitalization in the U.S., 1979 to 2004. J Am Coll Cardiol. 2008;52(6):428–34.

    Article  PubMed  Google Scholar 

  12. Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355(3):251–9.

    Article  PubMed  CAS  Google Scholar 

  13. Kindermann M, Reil JC, Pieske B, van Veldhuisen DJ, Bohm M. Heart failure with normal left ventricular ejection fraction: what is the evidence? Trends Cardiovasc Med. 2008;18(8):280–92.

    Article  PubMed  Google Scholar 

  14. • Steinberg BA, Zhao X, Heidenreich PA, et al. Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation. 2012;126(1):65–75. This study examined trends in prevalence and hospitalization rate for HFpEF versus HFrEF patients. It reported on an increase in hospitalizations for HFpEF, versus a stable hospitalization rate for HFrEF patients.

    Article  PubMed  Google Scholar 

  15. Cleland JG, Tendera M, Adamus J, et al. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J. 2006;27(19):2338–45.

    Article  PubMed  CAS  Google Scholar 

  16. Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-preserved trial. Lancet. 2003;362(9386):777–81.

    Article  PubMed  CAS  Google Scholar 

  17. van Veldhuisen DJ, Cohen-Solal A, Bohm M, et al. Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction: data from SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure). J Am Coll Cardiol. 2009;53(23):2150–8.

    Article  PubMed  Google Scholar 

  18. •• Holland DJ, Kumbhani DJ, Ahmed SH, Marwick TH. Effects of treatment on exercise tolerance, cardiac function, and mortality in heart failure with preserved ejection fraction. A meta-analysis. J Am Coll Cardiol. 2011;57(16):1676–86. This study sought to determine whether pharmacologic interventions changed outcome for HFpEF, in a meta-analysis. It showed that pharmacotherapy of HFpEF demonstrates a quantifiable improvement in exercise tolerance, but not mortality.

    Article  PubMed  Google Scholar 

  19. Roger VL. The heart failure epidemic. Int J Environ Res Public Health. 2010;7(4):1807–30.

    Article  PubMed  Google Scholar 

  20. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285(26):1441–6.

    Article  PubMed  CAS  Google Scholar 

  21. Schocken DD, Arrieta MI, Leaverton PE, Ross EA. Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol. 1992;20(2):301–6.

    Article  PubMed  CAS  Google Scholar 

  22. Authors/Task Force Members, McMurray JJ, Adamopoulos S, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012;14(8):803–69.

    Article  PubMed  CAS  Google Scholar 

  23. Feenstra J, Heerdink ER, Grobbee DE, Stricker BH. Association of nonsteroidal anti-inflammatory drugs with first occurrence of heart failure and with relapsing heart failure: the Rotterdam Study. Arch Intern Med. 2002;162(3):265–70.

    Article  PubMed  CAS  Google Scholar 

  24. Gottdiener JS, Arnold AM, Aurigemma GP, et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol. 2000;35(6):1628–37.

    Article  PubMed  CAS  Google Scholar 

  25. Krumholz HM, Butler J, Miller J, et al. Prognostic importance of emotional support for elderly patients hospitalized with heart failure. Circulation. 1998;97(10):958–64.

    Article  PubMed  CAS  Google Scholar 

  26. Hoffman RM, Psaty BM, Kronmal RA. Modifiable risk factors for incident heart failure in the coronary artery surgery study. Arch Intern Med. 1994;154(4):417–23.

    Article  PubMed  CAS  Google Scholar 

  27. Bertoni AG, Hundley WG, Massing MW, et al. Heart failure prevalence, incidence, and mortality in the elderly with diabetes. Diabetes Care. 2004;27(3):699–703.

    Article  PubMed  Google Scholar 

  28. Nichols GA, Hillier TA, Erbey JR, Brown JB. Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. Diabetes Care. 2001;24(9):1614–9.

    Article  PubMed  CAS  Google Scholar 

  29. Ix JH, Shlipak MG, Chertow GM, Whooley MA. Association of cystatin C with mortality, cardiovascular events, and incident heart failure among persons with coronary heart disease: data from the Heart and Soul Study. Circulation. 2007;115(2):173–9.

    Article  PubMed  CAS  Google Scholar 

  30. Mokhles MM, Trifiro G, Dieleman JP, et al. The risk of new onset heart failure associated with dopamine agonist use in Parkinson's disease. Pharmacol Res. 2012;65(3):358–64.

    Article  PubMed  CAS  Google Scholar 

  31. Agarwal SK, Heiss G, Barr RG, et al. Airflow obstruction, lung function, and risk of incident heart failure: the Atherosclerosis Risk in Communities (ARIC) study. Eur J Heart Fail. 2012;14(4):414–22.

    Article  PubMed  Google Scholar 

  32. Bibbins-Domingo K, Pletcher MJ, Lin F, et al. Racial differences in incident heart failure among young adults. N Engl J Med. 2009;360(12):1179–90.

    Article  PubMed  CAS  Google Scholar 

  33. Husaini BA, Mensah GA, Sawyer D, et al. Race, sex, and age differences in heart failure-related hospitalizations in a southern state: implications for prevention. Circ Heart Fail. 2011;4(2):161–9.

    Article  PubMed  Google Scholar 

  34. Alexander M, Grumbach K, Selby J, Brown AF, Washington E. Hospitalization for congestive heart failure. Explaining racial differences. JAMA. 1995;274(13):1037–42.

    Article  PubMed  CAS  Google Scholar 

  35. Fox KF, Cowie MR, Wood DA, et al. Coronary artery disease as the cause of incident heart failure in the population. Eur Heart J. 2001;22(3):228–36.

    Article  PubMed  CAS  Google Scholar 

  36. Smith JG, Newton-Cheh C, Almgren P, et al. Assessment of conventional cardiovascular risk factors and multiple biomarkers for the prediction of incident heart failure and atrial fibrillation. J Am Coll Cardiol. 2010;56(21):1712–9.

    Article  PubMed  Google Scholar 

  37. Senni M, Tribouilloy CM, Rodeheffer RJ, et al. Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation. 1998;98(21):2282–9.

    Article  PubMed  CAS  Google Scholar 

  38. Cowie MR, Wood DA, Coats AJ, et al. Incidence and aetiology of heart failure; a population-based study. Eur Heart J. 1999;20(6):421–8.

    Article  PubMed  CAS  Google Scholar 

  39. Hogg K, Swedberg K, McMurray J. Heart failure with preserved left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol. 2004;43(3):317–27.

    Article  PubMed  Google Scholar 

  40. Rusinaru D, Leborgne L, Peltier M, Tribouilloy C. Effect of atrial fibrillation on long-term survival in patients hospitalised for heart failure with preserved ejection fraction. Eur J Heart Fail. 2008;10(6):566–72.

    Article  PubMed  Google Scholar 

  41. •• Ho JE, Gona P, Pencina MJ, et al. Discriminating clinical features of heart failure with preserved vs. reduced ejection fraction in the community. Eur Heart J. 2012. This cohort from the Framingham Heart Study is one of the few with data on new onset HFrEF and HFpEF, in a community-based population. It shows several different pre-onset and clinical characteristics at the time of heart failure presentation.

  42. Lee DS, Gona P, Vasan RS, et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the national heart, lung, and blood institute. Circulation. 2009;119(24):3070–7.

    Article  PubMed  Google Scholar 

  43. Chinali M, Joffe SW, Aurigemma GP, et al. Risk factors and comorbidities in a community-wide sample of patients hospitalized with acute systolic or diastolic heart failure: the Worcester Heart Failure Study. Coron Artery Dis. 2010;21(3):137–43.

    Article  PubMed  Google Scholar 

  44. Damman K, Voors AA, Navis G, van Veldhuisen DJ, Hillege HL. The cardiorenal syndrome in heart failure. Prog Cardiovasc Dis. 2011;54(2):144–53.

    Article  PubMed  Google Scholar 

  45. Carrasco-Sanchez FJ, Galisteo-Almeda L, Paez-Rubio I, et al. Prognostic value of cystatin C on admission in heart failure with preserved ejection fraction. J Card Fail. 2011;17(1):31–8.

    Article  PubMed  CAS  Google Scholar 

  46. Liu M, Chan CP, Yan BP, et al. Albumin levels predict survival in patients with heart failure and preserved ejection fraction. Eur J Heart Fail. 2012;14(1):39–44.

    Article  PubMed  CAS  Google Scholar 

  47. Blecker S, Matsushita K, Kottgen A, et al. High-normal albuminuria and risk of heart failure in the community. Am J Kidney Dis. 2011;58(1):47–55.

    Article  PubMed  CAS  Google Scholar 

  48. Sarnak MJ, Katz R, Stehman-Breen CO, et al. Cystatin C concentration as a risk factor for heart failure in older adults. Ann Intern Med. 2005;142(7):497–505.

    PubMed  CAS  Google Scholar 

  49. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993;88(1):107–15.

    Article  PubMed  CAS  Google Scholar 

  50. Mosterd A, Cost B, Hoes AW, et al. The prognosis of heart failure in the general population: the Rotterdam Study. Eur Heart J. 2001;22(15):1318–27.

    Article  PubMed  CAS  Google Scholar 

  51. Cowie MR, Wood DA, Coats AJ, et al. Survival of patients with a new diagnosis of heart failure: a population based study. Heart. 2000;83(5):505–10.

    Article  PubMed  CAS  Google Scholar 

  52. Levy D, Kenchaiah S, Larson MG, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002;347(18):1397–402.

    Article  PubMed  Google Scholar 

  53. Rickenbacher P, Pfisterer M, Burkard T, et al. Why and how do elderly patients with heart failure die? Insights from the TIME-CHF study. Eur J Heart Fail. 2012.

  54. Hamaguchi S, Kinugawa S, Sobirin MA, et al. Mode of death in patients with heart failure and reduced vs. Preserved ejection fraction. Circ J. 2012;76(7):1662–9.

    PubMed  Google Scholar 

  55. Velagaleti RS, Gona P, Larson MG, et al. Multimarker approach for the prediction of heart failure incidence in the community. Circulation. 2010;122(17):1700–6.

    Article  PubMed  Google Scholar 

  56. Butler J, Kalogeropoulos A, Georgiopoulou V, et al. Incident heart failure prediction in the elderly: the health ABC heart failure score. Circ Heart Fail. 2008;1(2):125–33.

    Article  PubMed  Google Scholar 

  57. Pfister R, Sharp SJ, Luben R, Wareham NJ, Khaw KT. Plasma vitamin C predicts incident heart failure in men and women in European Prospective Investigation into Cancer and Nutrition-Norfolk prospective study. Am Heart J. 2011;162(2):246–53.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands

    Frank P. Brouwers, Hans L. Hillege, Wiek H. van Gilst & Dirk J. van Veldhuisen

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  1. Frank P. Brouwers
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  2. Hans L. Hillege
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  4. Dirk J. van Veldhuisen
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Correspondence to Frank P. Brouwers.

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Brouwers, F.P., Hillege, H.L., van Gilst, W.H. et al. Comparing New Onset Heart Failure with Reduced Ejection Fraction and New Onset Heart Failure with Preserved Ejection Fraction: An Epidemiologic Perspective. Curr Heart Fail Rep 9, 363–368 (2012). https://doi.org/10.1007/s11897-012-0115-7

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  • DOI: https://doi.org/10.1007/s11897-012-0115-7

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