Heart Failure with Preserved Ejection Fraction in Brazil: A Systematic Review

Abstract

Heart failure with preserved ejection fraction (HFpEF) is the most common condition of heart failure (HF) in patients over 65 years of age and is associated with high morbidity and mortality. Epidemiological data on this condition are still scarce in Brazil and these data are relevant for a better understanding of the impact and unmet needs in HFpEF and for the planning of actions to improve prevention, diagnosis, and treatment of this disease.The objective of the study was to identify evidence on the epidemiology and clinical characteristics of Brazilian patients with HFpEF.We systematically reviewed observational and clinical studies evaluating epidemiological and clinical data of Brazilian patients with HFpEF in the Pubmed/MEDLINE and LILACS databases, following PRISMA guidelines.The prevalence of HFpEF in patients with confirmed HF ranged from 28.2 to 59.0% in the outpatient setting and from 20.0% to 53.1% in the hospital setting. Among patients with suspected HF, the prevalence of patients with LVEF>50% ranged from 29.0 to 37.6%. The most frequently reported comorbidities were systemic arterial hypertension and diabetes, with a prevalence of 57.4 to 100.0% in studies involving only patients with HFpEF, and from 10.2 to 49.1% in studies on patients with HF with normal ejection fraction (n = 14). Data on mortality and hospitalization rates were scarce.Despite few and heterogeneous data on the prevalence of HFpEF in Brazil, the prevalence of this condition in primary care patients and in hospitalized patients was relatively high.

Clustering of Cardiovascular Risk Factors and Heart Failure in Older Adults from the Brazilian Far North

“…Secondly, the lack of complete outcome data raises the possibility of underreporting, affecting the accuracy and comprehensiveness of the conclusions. Despite the considerable percentage of older adults with missing data, it is unlikely to have introduced bias in the results, given the sample size, which exceeded some previous studies on the topic [23]. However, underreporting may have occurred in the final sample due to general practitioners' difficulties in diagnosing HF.…”

“…Among the 13 studies analyzed, heterogeneities were observed, including sample sizes ranging from 25 to 2056 participants, as well as different types of designs and treatment locations, both outpatient and inpatient. Surprisingly, some of the prevalences found exceeded 50%, and none of the available studies analyzed the association between HF and clustering of cardiovascular risk factors [23].…”

“…These findings raise concerns for Brazil, which experienced a significant increase of 57.4% in HF incidence in its older adult population between 2010 and 2022 [22]. However, despite demographic growth, understanding of HF in Brazil remains incomplete, as revealed by a recent systematic review [23]. Among the 13 studies analyzed, heterogeneities were observed, including sample sizes ranging from 25 to 2056 participants, as well as different types of designs and treatment locations, both outpatient and inpatient.…”

“…Even though there have been advances in the treatment of HF, many patients still face residual risks of adverse events, necessitating the exploration of new therapeutic targets [26]. Given HF's propensity to predominantly affect older adult patients and the scarcity of data on its clinical characteristics in Brazilian populations [23], generating epidemiological information is crucial. These data are essential for guiding healthcare professionals and policymakers in managing HF, identifying high-risk groups, and potentially improving patient outcomes.…”