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Previous Volume 355:251-259 July 20, 2006 Number 3 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Aurigemma, G. P. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The prevalence of heart failure with preserved ejection fraction may be changing as a result of changes in population demographics and in the prevalence and treatment of risk factors for heart failure. Changes in the prevalence of heart failure with preserved ejection fraction may contribute to changes in the natural history of heart failure. We performed a study to define secular trends in the prevalence of heart failure with preserved ejection fraction among patients at a single institution over a 15-year period.

Methods We studied all consecutive patients hospitalized with decompensated heart failure at Mayo Clinic Hospitals in Olmsted County, Minnesota, from 1987 through 2001. We classified patients as having either preserved or reduced ejection fraction. The patients were also classified as community patients (Olmsted County residents) or referral patients. Secular trends in the type of heart failure, associated cardiovascular disease, and survival were defined.

Results A total of 6076 patients with heart failure were discharged over the 15-year period; data on ejection fraction were available for 4596 of these patients (76 percent). Of these, 53 percent had a reduced ejection fraction and 47 percent had a preserved ejection fraction. The proportion of patients with the diagnosis of heart failure with preserved ejection fraction increased over time and was significantly higher among community patients than among referral patients (55 percent vs. 45 percent). The prevalence rates of hypertension, atrial fibrillation, and diabetes among patients with heart failure increased significantly over time. Survival was slightly better among patients with preserved ejection fraction (adjusted hazard ratio for death, 0.96; P=0.01). Survival improved over time for those with reduced ejection fraction but not for those with preserved ejection fraction.

Conclusions The prevalence of heart failure with preserved ejection fraction increased over a 15-year period, while the rate of death from this disorder remained unchanged. These trends underscore the 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.

Full Text of this Article

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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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