Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction
Theophilus E. Owan, M.D., David O. Hodge, M.S., Regina M. Herges, B.S., Steven J. Jacobsen, M.D., Ph.D., Veronique L. Roger, M.D., M.P.H., and Margaret M. Redfield, M.D.
Background The prevalence of heart failure with preserved ejectionfraction may be changing as a result of changes in populationdemographics and in the prevalence and treatment of risk factorsfor heart failure. Changes in the prevalence of heart failurewith preserved ejection fraction may contribute to changes inthe natural history of heart failure. We performed a study todefine secular trends in the prevalence of heart failure withpreserved ejection fraction among patients at a single institutionover a 15-year period.
Methods We studied all consecutive patients hospitalized withdecompensated heart failure at Mayo Clinic Hospitals in OlmstedCounty, Minnesota, from 1987 through 2001. We classified patientsas having either preserved or reduced ejection fraction. Thepatients were also classified as community patients (OlmstedCounty residents) or referral patients. Secular trends in thetype of heart failure, associated cardiovascular disease, andsurvival were defined.
Results A total of 6076 patients with heart failure were dischargedover the 15-year period; data on ejection fraction were availablefor 4596 of these patients (76 percent). Of these, 53 percenthad a reduced ejection fraction and 47 percent had a preservedejection fraction. The proportion of patients with the diagnosisof heart failure with preserved ejection fraction increasedover time and was significantly higher among community patientsthan among referral patients (55 percent vs. 45 percent). Theprevalence rates of hypertension, atrial fibrillation, and diabetesamong patients with heart failure increased significantly overtime. Survival was slightly better among patients with preservedejection fraction (adjusted hazard ratio for death, 0.96; P=0.01).Survival improved over time for those with reduced ejectionfraction but not for those with preserved ejection fraction.
Conclusions The prevalence of heart failure with preserved ejectionfraction increased over a 15-year period, while the rate ofdeath from this disorder remained unchanged. These trends underscorethe importance of this growing public health problem.
Source Information
From the Cardiorenal Research Laboratory (T.E.O., M.M.R.), the Division of Biostatistics (D.O.H., R.M.H.), and the Section of Health Science Research (S.J.J., V.L.R.), Mayo Clinic College of Medicine, Rochester, Minn.
Address reprint requests to Dr. Redfield at Cardiovascular Research, Guggenheim 9, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, or at redfield.margaret{at}mayo.edu.
Heart Failure with Preserved Ejection Fraction
Fiack C. A., Farber H. W., Arias M. A., Alonso-Fernández A., García-Río F., Kessler K. M., Ahmed A., Fleg J. L., Gheorghiade M., Owan T. E., Redfield M. M., Liu P. P., Lee D. S., Tu J. V., Ph.D. M.D.
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N Engl J Med 2006;
355:1828-1831, Oct 26, 2006.
Correspondence
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