The emerging epidemic of heart failure with preserved ejection fraction

Abstract

Heart failure with preserved ejection fraction (HFpEF), which currently represents approximately 50 % of heart failure (HF) cases, is common and associated with high morbidity and mortality. Understanding the epidemiology of HFpEF has been difficult due to the challenges in HFpEF diagnosis and the heterogeneous etiologies and pathophysiologies that underlie HFpEF. Nevertheless, several high-quality epidemiology and observational registry studies of HFpEF demonstrate that an increasing prevalence of HFpEF in both the outpatient and inpatient settings, coupled with a lack of evidence-based effective treatments for HFpEF, is resulting in an emerging epidemic of HFpEF. In this review, we discuss the emerging HFpEF epidemic, focusing on: (1) reasons for the rising prevalence of HFpEF; (2) the abnormalities in cardiac structure and function that dictate the transition from risk factors to HFpEF; (3) novel HFpEF mechanisms that may underlie the increase in HFpEF prevalence; (4) prognosis of HFpEF; and (5) risk prediction in HFpEF. We conclude with 10 unanswered questions onHFpEF epidemiology thatwill be important areas for future investigation.

Fig. 1

The Changing Landscape of Heart Failure: The Projected Trajectory of HFpEF in Hospitalized Heart Failure Patients. Based on results from Get With the Guidelines-Heart Failure (GWTG-HF) Study (Steinberg et al. [11••]; N=110,621), using actual data on the proportion of hospitalization patients with three types of HF (HFpEF [EF>50 %]; HFrEF [EF<40 %]; and HF borderline-EF [EF 40–50 %]) at each time point between 2005–2010. The trajectories for 2011–2020 were estimated for HFpEF and HFrEF using linear regression analyses, while HF borderline-EF was held at a constant 14 % proportion of hospitalized HF patients. The regression equation for the projected HFpEF trajectory=−0.86(Year)+1771 (P=0.015 for the trend of decreasing HFrEF over time); the equation for the projected HFrEF trajectory= 1.086(Year)-2144 (P=0.008 for the trend of increasing HFpEF over time).