Key result
Combined Framingham, peptide, and echo criteria linked to ~2-fold higher mortality and HF hospitalization in HFpEF.
Why the study?
The prognostic impact of Framingham criteria for heart failure in patients with stable HFpEF had not been established.
Does meeting the Framingham criteria for heart failure and other descriptive models predict the composite of all-cause mortality and HF hospitalization in stable HFpEF patients?
Cohort (n=399)
Yes
Does meeting the Framingham criteria for heart failure and other descriptive models predict the composite of all-cause mortality and HF hospitalization in stable HFpEF patients?
Residual Framingham criteria in stable HFpEF patients tend to be associated with an increased risk for mortality and HF hospitalization, particularly when reinforced by natriuretic peptide and echocardiographic criteria.
Answers are grounded in this paper and cite their sources.
May signal higher risk in stable HFpEF; leaves open whether Framingham criteria enhance stratification beyond natriuretic peptides and echocardiography.
AIMS: This study aims to assess prognostic impact of Framingham criteria for heart failure (FC-HF) in patients with stable heart failure (HF) with preserved ejection fraction (HFpEF). METHODS AND RESULTS: In the prospective Karolinska-Rennes (KaRen) study, we assessed stable HFpEF patients after an acute HF episode. We evaluated associations between the four descriptive models of HFpEF and the composite endpoint of all-cause mortality and HF hospitalization. The descriptive models were FC-HF alone, FC-HF + natriuretic peptides (NPs) according to the PARAGON trial, FC-HF + NPs + echocardiographic HFpEF criteria according to European Society of Cardiology HF guidelines, and FC-HF + NPs + echocardiographic criteria according to the PARAGON trial. Out of the 539 patients enrolled in KaRen, 438 returned for the stable state revisit after 4-8 weeks, 13 (2.4%) patients died before the planned follow-up, and 88 patients (16%) declined or were unable to return. Three hundred ninety-nine patients have FC registered at follow-up, and among these, the four descriptive models were met in 107 (27%), 82 (22%), 61 (21%), and 69 (22%) patients, and not met in 292 (73%). The 107 patients that had FC-HF at stable state (descriptive model 1) could also be part of the other models because all patients in models 1-4 had to fulfil the FC-HF. The patients in model 0 did not fulfil the criteria for FC-HF but could have single FC. Of single FC, only pleural effusion predicted the endpoint [hazard ratio (HR) 3.38, 95% confidence interval (CI) 1.47-7.76, P = 0.004]. Patients without FC-HF had better prognosis than patients meeting FC-HF. The unadjusted associations between the four HFpEF descriptive models and the endpoint were HR 1.54, 95% CI 1.14-2.09, P = 0.005; HR 1.71, 95% CI 1.24-2.36, P = 0.002; HR 1.95, 95% CI 1.36-2.81, P = 0.001; and HR 2.05, 95% CI 1.45-2.91, P < 0.001, for descriptive models 1-4, respectively. No descriptive model independently predicted the endpoint. CONCLUSIONS: In ambulatory HFpEF patients, a quarter met FC-HF, while most met NP and echocardiography criteria for HF. Residual FC-HF tended to be associated with increased risk for mortality and HF hospitalization, further strengthened by NPs and echocardiographic criteria, highlighting its role in clinical risk assessment.
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Löfström et al. (2019) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=399). Meeting Framingham criteria for heart failure combined with natriuretic peptides and echocardiography (Descriptive Model 4) vs. Patients without Framingham criteria for heart failure (Model 0) was evaluated on Composite of all-cause mortality and heart failure hospitalization (HR 2.05, 95% CI 1.45-2.91, p=<0.001). In ambulatory HFpEF patients, fulfilling Framingham criteria combined with natriuretic peptide and echocardiographic criteria was associated with a higher unadjusted risk of mortality and HF hospitalization (HR 2.05).
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