Current Heart Failure Reports

, Volume 9, Issue 4, pp 363–368

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

  • Frank P. Brouwers
  • Hans L. Hillege
  • Wiek H. van Gilst
  • Dirk J. van Veldhuisen
Epidemiology of Heart Failure (J Butler, Section Editor)

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.

Keywords

New onset heart failure Left ventricular ejection fraction HFrEF HFpEF Epidemiology Prevention 

References

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

  1. 1.
    Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93(9):1137–46.PubMedCrossRefGoogle Scholar
  2. 2.
    Owan TE, Redfield MM. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis. 2005;47(5):320–32.PubMedCrossRefGoogle Scholar
  3. 3.
    Cheng S, Vasan RS. Advances in the epidemiology of heart failure and left ventricular remodeling. Circulation. 2011;124(20):e516–9.PubMedCrossRefGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 5.
    Shin JJ, Hamad E, Murthy S, Pina IL. Heart failure in women. Clin Cardiol. 2012;35(3):172–7.PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 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.PubMedGoogle Scholar
  8. 8.
    Dhingra R, Vasan RS. Diabetes and the risk of heart failure. Heart Fail Clin. 2012;8(1):125–33.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 10.
    O'Connell JB. The economic burden of heart failure. Clin Cardiol. 2000;23(3 Suppl):III6–10.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 19.
    Roger VL. The heart failure epidemic. Int J Environ Res Public Health. 2010;7(4):1807–30.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedCrossRefGoogle Scholar
  28. 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.PubMedCrossRefGoogle Scholar
  29. 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.PubMedCrossRefGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. 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.PubMedCrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 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.PubMedCrossRefGoogle Scholar
  38. 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.PubMedCrossRefGoogle Scholar
  39. 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.PubMedCrossRefGoogle Scholar
  40. 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.PubMedCrossRefGoogle Scholar
  41. 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. Google Scholar
  42. 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.PubMedCrossRefGoogle Scholar
  43. 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.PubMedCrossRefGoogle Scholar
  44. 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.PubMedCrossRefGoogle Scholar
  45. 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.PubMedCrossRefGoogle Scholar
  46. 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.PubMedCrossRefGoogle Scholar
  47. 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.PubMedCrossRefGoogle Scholar
  48. 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.PubMedGoogle Scholar
  49. 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.PubMedCrossRefGoogle Scholar
  50. 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.PubMedCrossRefGoogle Scholar
  51. 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.PubMedCrossRefGoogle Scholar
  52. 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.PubMedCrossRefGoogle Scholar
  53. 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.Google Scholar
  54. 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.PubMedGoogle Scholar
  55. 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.PubMedCrossRefGoogle Scholar
  56. 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.PubMedCrossRefGoogle Scholar
  57. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Frank P. Brouwers
    • 1
  • Hans L. Hillege
    • 1
  • Wiek H. van Gilst
    • 1
  • Dirk J. van Veldhuisen
    • 1
  1. 1.Department of CardiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands

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