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Age-dependent differences in clinical phenotype and prognosis in heart failure with mid-range ejection compared with heart failure with reduced or preserved ejection fraction

  • Xiaojing ChenEmail author
  • Gianluigi Savarese
  • Ulf Dahlström
  • Lars H. Lund
  • Michael Fu
Original Paper
  • 105 Downloads

Abstract

Background

HFmrEF has been recently proposed as a distinct HF phenotype. How HFmrEF differs from HFrEF and HFpEF according to age remains poorly defined. We aimed to investigate age-dependent differences in heart failure with mid-range (HFmrEF) vs. preserved (HFpEF) and reduced (HFrEF) ejection fraction.

Methods and results

42,987 patients, 23% with HFpEF, 22% with HFmrEF and 55% with HFrEF, enrolled in the Swedish heart failure registry were studied. HFpEF prevalence strongly increased, whereas that of HFrEF strongly decreased with higher age. All cardiac comorbidities and most non-cardiac comorbidities increased with aging, regardless of the HF phenotype. Notably, HFmrEF resembled HFrEF for ischemic heart disease prevalence in all age groups, whereas regarding hypertension it was more similar to HFpEF in age ≥ 80 years, to HFrEF in age < 65 years and intermediate in age 65–80 years. All-cause mortality risk was higher in HFrEF vs. HFmrEF for all age categories, whereas HFmrEF vs. HFpEF reported similar risk in ≥ 80 years old patients and lower risk in < 65 and 65–80 years old patients. Predictors of mortality were more likely cardiac comorbidities in HFrEF but more likely non-cardiac comorbidities in HFpEF and HFmrEF with < 65 years. Differences among HF phenotypes for comorbidities were less pronounced in the other age categories.

Conclusion

HFmrEF appeared as an intermediate phenotype between HFpEF and HFrEF, but for some characteristics such as ischemic heart disease more similar to HFrEF. With aging, HFmrEF resembled more HFpEF. Prognosis was similar in HFmrEF vs. HFpEF and better than in HFrEF.

Keywords

HFmrEF HFrEF HFpEF Age Prognosis 

Notes

Funding

This study is supported by the Swedish Heart–Lung Foundation, the Swedish agreement between the government and the county councils concerning economic support for providing an infrastructure for research and education of doctors (ALF) and the Regional Development Fund, Västra Götaland County, Sweden (FOU-VGR).

Compliance with ethical standards

Conflict of interest

Xiaojing Chen: none. Gianluigi Savarese: none relevant for the present work. Unrelated to the present work: Research funding from the Italian Society of Cardiology on behalf of MSD Italia-Merck Sharp & Dohme Corporation; travel grants from Heart and Lung Foundation. Ulf Dahlström: none. Lars H. Lund: research grants to author’s institution: AstraZeneca, Novartis, Boston Scientiifc; speaker’s honoraria: AstraZeneca, Novartis, StJude, Merck; consulting honoraria: AstraZeneca, Novartis, Sanofi, Bayer, Vifor Pharma, Relypsa, Merck, HeartWare. Micheal Fu: none relevant for the present work. Unrelated to the present work: research funding and/or honoraria from AstraZeneca, Novartis, TRIOMED, and SERVIER.

Supplementary material

392_2019_1477_MOESM1_ESM.docx (40 kb)
Supplementary material 1 (DOCX 40 kb)

Reference

  1. 1.
    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the heart failure association (HFA) of the ESC. Eur Heart J 37:2129–2200CrossRefGoogle Scholar
  2. 2.
    Stein GY, Kremer A, Shochat T, Bental T, Korenfeld R, Abramson E et al (2012) The diversity of heart failure in a hospitalized population: the role of age. J Card Fail 18:645–653CrossRefGoogle Scholar
  3. 3.
    Kerzner R, Gage BF, Freedland KE, Rich MW (2003) Predictors of mortality in younger and older patients with heart failure and preserved or reduced left ventricular ejection fraction. Am Heart J 146:286–290CrossRefGoogle Scholar
  4. 4.
    Paren P, Schaufelberger M, Bjorck L, Lappas G, Fu M, Rosengren A (2014) Trends in prevalence from 1990 to 2007 of patients hospitalized with heart failure in Sweden. Eur J Heart Fail 16:737–742CrossRefGoogle Scholar
  5. 5.
    Conde-Martel A, Formiga F, Perez-Bocanegra C, Armengou-Arxe A, Muela-Molinero A, Sanchez-Sanchez C et al (2013) Clinical characteristics and 1-year survival in heart failure patients more than 85 years of age compared with younger. Eur J Intern Med 24:339–345CrossRefGoogle Scholar
  6. 6.
    Koifman E, Kopel E, Medvedovsky D, Maor E, Hamdan A, Goldenberg I et al (2013) Age-dependent effect of left ventricular ejection fraction on long-term mortality in patients with heart failure (from the Heart Failure Survey in ISrael). Am J Cardiol 112:1901–1906CrossRefGoogle Scholar
  7. 7.
    Mahjoub H, Rusinaru D, Souliere V, Durier C, Peltier M, Tribouilloy C (2008) Long-term survival in patients older than 80 years hospitalised for heart failure. A 5-year prospective study. Eur J Heart Fail 10:78–84CrossRefGoogle Scholar
  8. 8.
    Holmstrom A, Sigurjonsdottir R, Edner M, Jonsson A, Dahlstrom U, Fu ML (2013) Increased comorbidities in heart failure patients ≥ 85 years but declined from > 90 years: data from the Swedish Heart Failure Registry. Int J Cardiol 167:2747–2752CrossRefGoogle Scholar
  9. 9.
    Tschope C, Birner C, Bohm M, Bruder O, Frantz S, Luchner A et al (2018) Heart failure with preserved ejection fraction: current management and future strategies: expert opinion on the behalf of the nucleus of the “Heart Failure Working Group” of the German Society of Cardiology (DKG). Clin Res Cardiol 107:1–19CrossRefGoogle Scholar
  10. 10.
    Jonsson A, Edner M, Alehagen U, Dahlstrom U (2010) Heart failure registry: a valuable tool for improving the management of patients with heart failure. Eur J Heart Fail 12:25–31CrossRefGoogle Scholar
  11. 11.
    Lam CS, Solomon SD (2014) The middle child in heart failure: heart failure with mid-range ejection fraction (40–50%). Eur J Heart Fail 16:1049–1055CrossRefGoogle Scholar
  12. 12.
    Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF et al (2016) Precipitating clinical factors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction. JACC Heart Fail 4:464–472CrossRefGoogle Scholar
  13. 13.
    Cheng RK, Cox M, Neely ML, Heidenreich PA, Bhatt DL, Eapen ZJ et al (2014) Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population. Am Heart J 168:721–730CrossRefGoogle Scholar
  14. 14.
    MacDonald MR, Wee PP, Cao Y, Yang DM, Lee S, Tong KL et al (2016) Comparison of characteristics and outcomes of heart failure patients with preserved versus reduced ejection fraction in a multiethnic southeast Asian cohort. Am J Cardiol 118:1233–1238CrossRefGoogle Scholar
  15. 15.
    Salamanca-Bautista P, Conde-Martel A, Aramburu-Bodas O, Formiga F, Trullas JC, Quesada-Simon MA et al (2016) Precipitating factors of heart failure admission: differences related to age and left ventricular ejection fraction. Int J Cardiol 219:150–155CrossRefGoogle Scholar
  16. 16.
    Ho JE, Enserro D, Brouwers FP, Kizer JR, Shah SJ, Psaty BM et al (2016) Predicting heart failure with preserved and reduced ejection fraction: the international collaboration on heart failure subtypes. Circ Heart Fail 9:1941–3289CrossRefGoogle Scholar
  17. 17.
    Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade M, Greenberg BH et al (2007) Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF registry. J Am Coll Cardiol 50:768–777CrossRefGoogle Scholar
  18. 18.
    Bauer A, Khalil M, Ludemann M, Bauer J, Esmaeili A, De-Rosa R et al (2018) Creation of a restrictive atrial communication in heart failure with preserved and mid-range ejection fraction: effective palliation of left atrial hypertension and pulmonary congestion. Clin Res Cardiol 107:845–857CrossRefGoogle Scholar
  19. 19.
    Farmakis D, Simitsis P, Bistola V, Triposkiadis F, Ikonomidis I, Katsanos S et al (2017) Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome. Clin Res Cardiol 106:359–368CrossRefGoogle Scholar
  20. 20.
    Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A et al (2006) Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med 355:260–269CrossRefGoogle Scholar
  21. 21.
    Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251–259CrossRefGoogle Scholar
  22. 22.
    Tribouilloy C, Rusinaru D, Mahjoub H, Souliere V, Levy F, Peltier M et al (2008) Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study. Eur Heart J 29:339–347CrossRefGoogle Scholar
  23. 23.
    Cohn JN, Johnson G (1990) Heart failure with normal ejection fraction. The V-HeFT study. Veterans administration cooperative study group. Circulation 81:48–53Google Scholar
  24. 24.
    Ghali JK, Kadakia S, Bhatt A, Cooper R, Liao Y (1992) Survival of heart failure patients with preserved versus impaired systolic function: the prognostic implication of blood pressure. Am Heart J 123:993–997CrossRefGoogle Scholar
  25. 25.
    Kontogeorgos S, Thunstrom E, Johansson MC, Fu M (2017) Heart failure with preserved ejection fraction has a better long-term prognosis than heart failure with reduced ejection fraction in old patients in a 5-year follow-up retrospective study. Int J Cardiol 232:86–92CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of CardiologyWest China Hospital, Sichuan UniversityChengduChina
  2. 2.Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  3. 3.Division of Cardiology, Department of MedicineKarolinska InstitutetStockholmSweden
  4. 4.Department of Cardiology and Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
  5. 5.Heart and Vascular ThemeKarolinska University HospitalStockholmSweden

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