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64 Heart Failure with Preserved Ejection Fraction: Are the Current Definitions Too Strict?
  1. Hitesh Patel1,
  2. Carl Hayward1,
  3. Carlo di Mario1,
  4. Martin Cowie2,
  5. Alexander Lyon1,
  6. Stuart Rosen3
  1. 1NIHR Cardiovascular BRU, Royal Brompton Hospital
  2. 2Imperial College
  3. 3Royal Brompton Hospital

Abstract

Introduction To determine the impact of internationally recognised criteria for the diagnosis of heart failure with preserved ejection fraction (HF-PEF) on the identification of patients suitable for a clinical study of a novel therapeutic intervention.

Methods We reviewed the notes of 5883 patients admitted with heart failure across 8 hospitals in the UK. The criteria for diagnosis for HF-PEF included (Figure 1): ejection fraction (EF) >50%, structural remodelling, evidence of impaired diastolic function and the absence of significant other cause of symptoms, as recommended in the most recent ESC guidelines.

Abstract 64 Figure 1

The systematic filters and exclusions applied to all patients with hospitalised heart failure.EF = ejection fraction; AS- aortic stenosis; AR = aortic regurgitation; MS = mitral stenosis; HTN = hypertension; CKD- chronic kidney disease; eGFR = estimated glomerular filtration rate; IHD = ischaemic heart disease; CAD = coronary artery disease; LA = left atrial; LV = left ventricle; BNP = brain natriuretic peptide

Results Overall, 20.5% of patients had an EF >50% (Figure 2). There was significant heterogeneity between the hospitals as this proportion varied from 42.4% in the teaching hospitals to 13.8% in the district general hospitals (p < 0.0001). Removing individuals who had other diagnoses that could account for their symptoms reduced the cohort size from 1203 to 122 patients. Of the latter 122, only 45 people had evidence of structural cardiac remodelling and some evidence of raised cardiac filling pressures on echocardiography, consistent with HF-PEF.

Abstract 64 Figure 2

Box chart demonstrating the effects of applying 3 HF-PEF enriching filters to all hospitalised heart failure patients

Conclusion There may be a degree of under-diagnosis of HF-PEF in less specialised hospitals in the UK. Applying the current ESC criteria for HF-PEF for trial recruitment would limit enrolment to 3.7% of those who have an EF >50% and only 0.8% of all heart failure admissions. These data have important implications for the feasibility of clinical trials for HF-PEF, and for the generalisability of the results of such studies.

  • Heart Failure
  • Diagnosis
  • Epidemiology

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