Heart Failure in the General Population and Impact of the 2021 European Society of Cardiology Heart Failure Guidelines

Figures

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  Figure 1. Study PRISMA. From a total of 8263 subjects with available TTE examination, 1189 were excluded due to insufficient echocardiographic image quality or missing variables for HF classification. Following the 2021 ESC HF guidelines 342 participants were classified in the HF group. Of those, 37 were classified as HFrEF, 150 as HFmrEF, and 155 as HFpEF. ESC, European Society of Cardiology; LVEF, left ventricular ejection fraction; HCHS, Hamburg City Health Study; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; TTE, transthoracic echocardiography.

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  Figure 2. Prevalence of HF in the general population as well as the distribution of the different HF phenotypes. ALVSD, asymptomatic left ventricular systolic dysfunction; HF, heart failure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.

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  Figure 3. HF phenotypes and their different characteristics. ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin‐receptor neprilysin inhibitor; BMI, body mass index; DBP, diastolic blood pressure; DBP, diastolic blood pressure, GFR, glomerular filtration rate; ICD, implantable cardioverter‐defibrillator; MRA, mineralocorticoid receptor antagonist; NT‐proBNP, N‐terminal pro‐B‐type natriuretic peptide; OSAS, obstructive sleep apnoea; SGLT2i, Sodium‐glucose‐co‐transporter 2 inhibitor; SBP, systolic blood pressure.

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  Figure 4. Reclassification of subjects into the different HF phenotypes based on the 2016 ESC vs the 2021 ESC HF guidelines. ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin‐receptor neprilysin inhibitor; BMI, body mass index; DBP, diastolic blood pressure; DBP, diastolic blood pressure, GFR, glomerular filtration rate; ICD, implantable cardioverter‐defibrillator; MRA, mineralocorticoid receptor antagonist; NT‐proBNP, N‐terminal pro‐B‐type natriuretic peptide; OSAS, obstructive sleep apnoea; SGLT2i, Sodium‐glucose‐co‐transporter 2 inhibitor; SBP, systolic blood pressure.

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  Figure 5. Percentage of recommendations for guideline directed therapy within the HF population and the general population. ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin‐receptor neprilysin inhibitor; BMI, body mass index; DBP, diastolic blood pressure; DBP, diastolic blood pressure, GFR, glomerular filtration rate; ICD, implantable cardioverter‐defibrillator; MRA, mineralocorticoid receptor antagonist; NT‐proBNP, N‐terminal pro‐B‐type natriuretic peptide; OSAS, obstructive sleep apnoea; SGLT2i, Sodium‐glucose‐co‐transporter 2 inhibitor; SBP, systolic blood pressure.