Clinical epidemiology of heart failure with preserved ejection fraction (HFpEF) in comparatively young hospitalized patients

Abstract

Background While heart failure with preserved ejection fraction (HFpEF) is primarily a disease of old age, risk factors that contribute to HFpEF are not limited to older patients. The objectives of this population-based observational study were to describe the clinical epidemiology of HFpEF in younger (<65 years) as compared with older (≥65 years) patients hospitalized with acute decompensated heart failure. Methods and Results We reviewed the medical records of residents of central Massachusetts hospitalized with HFpEF at all 11 greater Worcester (MA) medical centers during the 5 study years of 1995, 2000, 2002, 2004, and 2006. Among the 2,398 patients hospitalized with confirmed HFpEF, 357 (14.9%) were <65 years old. Younger patients were more likely to be male, non-Caucasian, obese, and to have a history of diabetes and chronic kidney disease than older patients with HFpEF. Younger patients hospitalized with HFpEF were less likely to have received commonly prescribed cardiac medications, had a longer hospital stay, and experienced significantly lower post discharge death rates than older hospitalized patients. Conclusion While HFpEF is predominantly a disease of old age, data from longitudinal studies remains needed to identify risk factors in younger individuals that may predispose them to the development of HFpEF.

Contemporary economic burden in a real‐world heart failure population with Commercial and Medicare supplemental plans

“…Use of the LCED, primarily covering a commercial health plan including younger patients, allowed detailed description of HCRU/costs in this cohort. Total costs were highest among patients aged less than 50 years, primarily driven by longer inpatient stays, despite lower medication costs; findings supported by another US‐based study 15 . Younger patients also experienced shorter times to readmission.…”

Chronic Sildenafil Therapy in the ZSF1 Obese Rat Model of Metabolic Syndrome and Heart Failure With Preserved Ejection Fraction

“…12 It is a young adult genetic male model of severe uncontrolled and untreated systemic arterial hypertension, obesity, metabolic syndrome and diabetes mellitus so it closely mimics a subgroup of younger, middle-aged, HFpEF patients that is increasing in prevalence. 15 Of note, ZSF1 obese rats are in sinus rhythm and lean ZSF1 littermates are also hypertensive, so, we used healthy WKY rats as control group. In the current work a shorter course of sildenafil, only 4 weeks compared with 25 weeks in Mátyás’s work, 23 started after HFpEF is established 12 and not as preventive therapy was able to reduce systemic arterial hypertension, to increase aortic compliance and decrease the impact of reflected waves on LV afterload as assessed by the augmentation index, to ameliorate diastolic LV function, reduce myocardial hypertrophy and interstitial fibrosis, and, finally, to modestly improve peak V˙O 2 and maximum workload during endurance effort.…”

“…This seems to be a growing group among HFpEF patients. 15 The aim of the present work is to evaluate in this experimental model the effect of chronic PDE5i therapy on exercise capacity, vascular function, LV hemodynamics and myocardial histology, bioenergetics and PKG activity as assessed by phosphorylation of Vasodilator-stimulated phosphoprotein (VASP).…”

Clonal haematopoiesis of indeterminate potential: intersections between inflammation, vascular disease and heart failure

“…Younger patients with HFpEF are more likely to be male and have a history of obesity and diabetes [142][143][144], both of which are strongly associated with chronic low-grade inflammation [142][143][144]. The presence of CHIP may be of even greater relevance in these younger patients as an indicator of increased epigenetic age.…”