Document Detail

Discriminating clinical features of heart failure with preserved vs. reduced ejection fraction in the community.
MedLine Citation:
PMID:  22507977     Owner:  NLM     Status:  MEDLINE    
AIMS: Heart failure (HF) is a major public health burden worldwide. Of patients presenting with HF, 30-55% have a preserved ejection fraction (HFPEF) rather than a reduced ejection fraction (HFREF). Our objective was to examine discriminating clinical features in new-onset HFPEF vs. HFREF.
METHODS AND RESULTS: Of 712 participants in the Framingham Heart Study (FHS) hospitalized for new-onset HF between 1981 and 2008 (median age 81 years, 53% female), 46% had HFPEF (EF >45%) and 54% had HFREF (EF ≤45%). In multivariable logistic regression, coronary heart disease (CHD), higher heart rate, higher potassium, left bundle branch block, and ischaemic electrocardiographic changes increased the odds of HFREF; female sex and atrial fibrillation increased the odds of HFPEF. In aggregate, these clinical features predicted HF subtype with good discrimination (c-statistic 0.78). Predictors were examined in the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. Of 4436 HF patients (median age 75 years, 47% female), 32% had HFPEF and 68% had HFREF. Distinguishing clinical features were consistent between FHS and EFFECT, with comparable discrimination in EFFECT (c-statistic 0.75). In exploratory analyses examining the traits of the intermediate EF group (EF 35-55%), CHD predisposed to a decrease in EF, whereas other clinical traits showed an overlapping spectrum between HFPEF and HFREF.
CONCLUSION: Multiple clinical characteristics at the time of initial HF presentation differed in participants with HFPEF vs. HFREF. While CHD was clearly associated with a lower EF, overlapping characteristics were observed in the middle of the left ventricular EF range spectrum.
Jennifer E Ho; Philimon Gona; Michael J Pencina; Jack V Tu; Peter C Austin; Ramachandran S Vasan; William B Kannel; Ralph B D'Agostino; Douglas S Lee; Daniel Levy
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-04-16
Journal Detail:
Title:  European heart journal     Volume:  33     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-16     Completed Date:  2012-10-09     Revised Date:  2013-07-02    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1734-41     Citation Subset:  IM    
National Heart, Lung, and Blood Institute, Framingham Heart Study, MA, USA.
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MeSH Terms
Age Factors
Aged, 80 and over
Arrhythmias, Cardiac / complications
Coronary Disease / complications
Heart Failure / diagnosis*,  physiopathology
Myocardial Ischemia / complications
Potassium / blood
Sex Factors
Stroke Volume / physiology
Ventricular Outflow Obstruction / diagnosis,  physiopathology
Grant Support
MOP 114937//Canadian Institutes of Health Research; N01-HC-25195/HC/NHLBI NIH HHS
Reg. No./Substance:
Comment In:
Eur Heart J. 2012 Jul;33(14):1716-7   [PMID:  22730487 ]

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