Title: Advances in the treatment of heart failure with a preserved ejection fraction
Introduction :Over the last several years it has become increasingly apparent that many patients with heart failure (HF) have a normal or nearly normal ejection fraction (EF) - described as heart failure with preserved ejection fraction (HF-PEF). Epidemiological studies [1-5]...
Introduction
:Over the last several years it has become
increasingly apparent that many patients with heart failure (HF) have a normal
or nearly normal ejection fraction (EF) - described as heart failure with
preserved ejection fraction (HF-PEF). Epidemiological studies [1-5] and patient
registries have reported a prevalence of up to 40-71% of patients with HF. A
recent study [6_] from Olmstead County found that the prevalence of HF-PEF among patients
with a discharge diagnosis of HF increased significantly from 1987 to 2001. The
prevalence of this condition will likely keep increasing as the prevalence of elderly
people with comorbid conditions such as hypertension, diabetes, obesity, and
coronary artery disease increases. Although the rates of mortality and
morbidity associated with HF-PEF and compared with HF due to depressed EF have
varied, there is consensus that HF-PEF is a condition associated with
substantial morbidity and mortality. The occurrence of clinical events
increases markedly once patients are hospitalized for HF. A recent review [1]
suggests that, once hospitalized for HF, patients with HF-PEF have a high rate
of rehospitalization; up to a third may be readmitted for HF exacerbation
within a year and about 45-60% may be hospitalized by 1 year for any reason.
Similarly, once hospitalized, the mortality may be as high as _22-29%
at 1 year and _65% at 5 years [6_,7_]. A study [6_] examining secular trends of HF within the
Olmstead County found that, although survival improved significantly over time
among patients with reduced EF, there was no trend toward improvement among
patients with HF-PEF. Thus, there exists an urgent need to develop effective
treatment strategies for patients with HF-PEF