Page 8 - SHJ V5 No2 2018
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SHJ Vol 5, No 2, 2018                                           Elbur MA Prognosis in HFpEF                                 By: Dr.Mohamed El

               REVIEW ARTICLE

                       Prognosis in heart failure with preserved ejection fraction

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

               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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