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© 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Aims

Understanding of the pathophysiology of progressive heart failure (HF) in patients with heart failure with preserved ejection fraction (HFpEF) is incomplete. We sought to identify factors differentially associated with risk of progressive HF death and hospitalization in patients with HFpEF compared with patients with HF and reduced ejection fraction (HFrEF).

Methods and results

Prospective cohort study of patients newly referred to secondary care with suspicion of HF, based on symptoms and signs of HF and elevated natriuretic peptides (NP), followed up for a minimum of 6 years. HFpEF and HFrEF were diagnosed according to the 2016 European Society of Cardiology guidelines. Of 960 patients referred, 467 had HFpEF (49%), 311 had HFrEF (32%), and 182 (19%) had neither. Atrial fibrillation (AF) was found in 37% of patients with HFpEF and 34% with HFrEF. During 6 years follow‐up, 19% of HFrEF and 14% of HFpEF patients were hospitalized or died due to progressive HF, hazard ratio (HR) 0.67 (95% CI: 0.47–0.96; P = 0.028). AF was the only marker that was differentially associated with progressive HF death or hospitalization in patients with HFpEF HR 2.58 (95% CI: 1.59–4.21; P < 0.001) versus HFrEF HR 1.11 (95% CI: 0.65–1.89; P = 0.7).

Conclusions

De novo patients diagnosed with HFrEF have greater risk of death or hospitalization due to progressive HF than patients with HFpEF. AF is associated with increased risk of progressive HF death or hospitalization in HFpEF but not HFrEF, raising the intriguing possibility that this may be a novel therapeutic target in this growing population.

Details

Title
Atrial fibrillation and risk of progressive heart failure in patients with preserved ejection fraction heart failure
Author
Gierula, John 1 ; Cole, Charlotte A. 1 ; Drozd, Michael 1 ; Lowry, Judith E. 1 ; Straw, Sam 1 ; Slater, Thomas A. 1 ; Paton, Maria F. 1 ; Byrom, Rowenna J. 2 ; Garland, Ellis 2 ; Halliday, Georgia 2 ; Winsor, Sarah 2 ; Lyall, Gemma K. 3 ; Birch, Karen 3 ; McGinlay, Melanie 2 ; Sunley, Emma 2 ; Grant, Peter J. 1 ; Wessels, David H. 4 ; Ketiar, Elias M. 4 ; Witte, Klaus K. 5 ; Cubbon, Richard M. 1 ; Kearney, Mark T. 1 

 Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK 
 Leeds Teaching Hospitals NHS Trust, Leeds, UK 
 Faculty of Biological Sciences, University of Leeds, Leeds, UK 
 Accelerated Enrollment Solutions, Horsham, PA, USA 
 Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK, University Clinic, RWTH, Aachen, DE, USA 
Pages
3254-3263
Section
Original Articles
Publication year
2022
Publication date
Oct 1, 2022
Publisher
John Wiley & Sons, Inc.
e-ISSN
20555822
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2743819795
Copyright
© 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.