Page 8 - SHJ V5 No2 2018

SHJ Vol 5, No 2, 2018 Elbur MA Prognosis in HFpEF By: Dr.Mohamed El
http://dx.doi.org/10.25239/SHJ/Vol5/No2/ReviewArticle

REVIEW ARTICLE

Prognosis in heart failure with preserved ejection fraction

Dr Mohamed Elbur. FRCP, DCM, DTCD. Consultant Cardiologist
Zayed Military Hospital, Abu Dhabi

Abstract
Heart Failure with preserved Ejection Fraction (HFpEF), like other heart failure syndromes, is
heterogeneous in etiology and pathophysiology, rather than a single disease. HFpEF may account
for about half of all patients with heart failure. Patients have symptoms and signs of HF with
normal or near normal left ventricular EF (LV EF>50 %). The classical risk factors for
developing HFpEF include advanced age and co-morbidities, notably hypertension, atrial
fibrillation, and the metabolic syndrome. When complicated by increasing congestion requiring
hospital admission, the prognosis is poor; 30% or more of such patients will die within 1 year
(nearly two-thirds die from cardiovascular causes). Patients with chronic stable symptoms have a
better prognosis. Patients with HFpEF represent an important group of patients presenting in
clinical practice with HF. Overall, it appears that patients with HFpEF are at lower risk of death
than patients with HFrEF, although mortality remains high in both groups. Application of the
same therapeutic hypotheses that have been successfully utilized among patients with HFrEF
have not been demonstrated to result in improved survival.

The syndrome of HFpEF has shown, on cardiopulmonary exercise testing). The
virtually every front, consensus-based management of HFrEF has improved
diagnostic criteria resulting in a significantly over the last two decades by
heterogeneous population challenging for contrast, little or no progress has been made
clinical studies and trials. Moreover, the in identifying evidence-based, effective
prevalence, morbidity, mortality, and treatments for HFpEF. Large phase III
healthcare costs of HFpEF is rising, in a international clinical trials investigating
similar way as HF with reduced EF interventions to improve outcomes in
(HFrEF). HFpEF have yielded disappointing
The aging population and increased life results.[3]
expectancy have led to the rising prevalence Irrespective of specific diagnostic criteria
of heart failure (HF) and despite the and cut-offs, HFpEF is a syndrome where
improvements in medical therapy, the multiple cardiac and vascular abnormalities,
mortality rate of this condition has remained cardiovascular risk factors, and overlapping
unacceptably high. [2] extra-cardiac comorbidities may be present
The diagnosis is generally made by history, in various combinations as shown in
physical examination and echocardiography (Table 1).
(with the possible addition of tests such as
plasma natriuretic peptide level or

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