Differential Clinical Profiles, Exercise Responses, and Outcomes Associated With Existing HFpEF Definitions
Key result
Applying different HFpEF definitions (ACC/AHA, ESC, HFSA) yielded cardiovascular event rates ranging from 75 to 298 per 1000 person-years, missing up to 85% of patients with physiologic HFpEF.
Why the study?
There is no consensus on how to define HFpEF across society and clinical trial criteria, and how patient clinical and hemodynamic profiles vary across definitions remains unclear.
How do clinical profiles, exercise responses, and cardiovascular outcomes vary when applying different societal and clinical trial definitions of HFpEF in patients with unexplained dyspnea?
Population
461 patients with chronic exertional dyspnea (NYHA II-IV) and EF ≥50% referred for invasive CPET
Comparison
Different societal (ACC/AHA vs ESC vs HFSA) and clinical trial HFpEF definitions
Design
Observational cohort study
Follow-up
Mean 3.8 years
Authors
Discussion
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Member takes
Implication
HFpEF definition choice alters outcome incidence; leaves open which criteria best stratify risk for prospective validation.
Study Design
Type
Cohort (n=461)
Structured PICO
How do clinical profiles, exercise responses, and cardiovascular outcomes vary when applying different societal and clinical trial definitions of HFpEF in patients with unexplained dyspnea?
P
Population
461 patients (mean age 58 years, 62% women) with chronic exertional dyspnea and ejection fraction ≥50%, followed for a mean of 3.8 years.
E
Exposure
Application of various societal (ACC/AHA, ESC, HFSA) and clinical trial definitions of Heart Failure with preserved Ejection Fraction (HFpEF).
C
Comparator
Comparison across different HFpEF definitions and against invasive hemodynamic evidence of HFpEF (abnormal rest or exercise filling pressures).
O
Outcome
Clinical profiles, exercise responses (peak oxygen uptake), and cardiovascular outcomes over a mean follow-up of 3.8 years.composite
Current societal and clinical trial definitions of HFpEF are highly heterogeneous, variably predicting cardiovascular events and failing to identify up to 85% of patients with invasive hemodynamic evidence of the disease.
Cite This Study
Ho et al. (2019) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=461). Different HFpEF definitions (ACC/AHA, ESC, HFSA) was evaluated on Cardiovascular outcomes. Applying different HFpEF definitions (ACC/AHA, ESC, HFSA) yielded cardiovascular event rates ranging from 75 to 298 per 1000 person-years, missing up to 85% of patients with physiologic HFpEF.