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37.3 Definition, epidemiology, and burden of disease: HFpEF
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Published:July 2018
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Abstract
Heart failure with preserved ejection fraction (HFpEF) is a global pandemic, affecting half of the heart failure population and with an incidence and prevalence expected to increase further with an ageing population. With no therapy to reduce morbidity or mortality, HFpEF has been defined as the single largest unmet need in cardiovascular medicine. As compared with heart failure with reduced ejection fraction (HFrEF), patients with HFpEF are more likely to be older and female, to have a higher prevalence of cardiovascular risk factors (i.e. obesity, hypertension, and diabetes), other cardiovascular co-morbidities (i.e. atrial fibrillation and valvular disease) and non-cardiovascular co-morbidities (i.e. anaemia, chronic pulmonary disease, and chronic kidney disease), but a lower prevalence of ischaemic heart disease. In non-selective cohorts and registries, crude but not adjusted mortality is higher in HFpEF vs. HFrEF, with risk of cardiovascular events lower in HFpEF, especially in clinical trial populations. A novel category, heart failure with mid-range ejection fraction (HFmrEF) has been introduced for an ejection fraction in the 40–49% range, to emphasize that this range is not normal but also has no evidence-based interventions. HFmrEF appears similar to HFrEF with regard to ischaemic heart disease prevalence and outcomes, but is intermediate between HFpEF and HFrEF in many other aspects.
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