Skip to main content

Advertisement

SpringerLink
Log in

Age-dependent differences in clinical phenotype and prognosis in heart failure with mid-range ejection compared with heart failure with reduced or preserved ejection fraction

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

HFmrEF has been recently proposed as a distinct HF phenotype. How HFmrEF differs from HFrEF and HFpEF according to age remains poorly defined. We aimed to investigate age-dependent differences in heart failure with mid-range (HFmrEF) vs. preserved (HFpEF) and reduced (HFrEF) ejection fraction.

Methods and results

42,987 patients, 23% with HFpEF, 22% with HFmrEF and 55% with HFrEF, enrolled in the Swedish heart failure registry were studied. HFpEF prevalence strongly increased, whereas that of HFrEF strongly decreased with higher age. All cardiac comorbidities and most non-cardiac comorbidities increased with aging, regardless of the HF phenotype. Notably, HFmrEF resembled HFrEF for ischemic heart disease prevalence in all age groups, whereas regarding hypertension it was more similar to HFpEF in age ≥ 80 years, to HFrEF in age < 65 years and intermediate in age 65–80 years. All-cause mortality risk was higher in HFrEF vs. HFmrEF for all age categories, whereas HFmrEF vs. HFpEF reported similar risk in ≥ 80 years old patients and lower risk in < 65 and 65–80 years old patients. Predictors of mortality were more likely cardiac comorbidities in HFrEF but more likely non-cardiac comorbidities in HFpEF and HFmrEF with < 65 years. Differences among HF phenotypes for comorbidities were less pronounced in the other age categories.

Conclusion

HFmrEF appeared as an intermediate phenotype between HFpEF and HFrEF, but for some characteristics such as ischemic heart disease more similar to HFrEF. With aging, HFmrEF resembled more HFpEF. Prognosis was similar in HFmrEF vs. HFpEF and better than in HFrEF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Reference

  1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the heart failure association (HFA) of the ESC. Eur Heart J 37:2129–2200

    Article  Google Scholar 

  2. Stein GY, Kremer A, Shochat T, Bental T, Korenfeld R, Abramson E et al (2012) The diversity of heart failure in a hospitalized population: the role of age. J Card Fail 18:645–653

    Article  Google Scholar 

  3. Kerzner R, Gage BF, Freedland KE, Rich MW (2003) Predictors of mortality in younger and older patients with heart failure and preserved or reduced left ventricular ejection fraction. Am Heart J 146:286–290

    Article  Google Scholar 

  4. Paren P, Schaufelberger M, Bjorck L, Lappas G, Fu M, Rosengren A (2014) Trends in prevalence from 1990 to 2007 of patients hospitalized with heart failure in Sweden. Eur J Heart Fail 16:737–742

    Article  Google Scholar 

  5. Conde-Martel A, Formiga F, Perez-Bocanegra C, Armengou-Arxe A, Muela-Molinero A, Sanchez-Sanchez C et al (2013) Clinical characteristics and 1-year survival in heart failure patients more than 85 years of age compared with younger. Eur J Intern Med 24:339–345

    Article  Google Scholar 

  6. Koifman E, Kopel E, Medvedovsky D, Maor E, Hamdan A, Goldenberg I et al (2013) Age-dependent effect of left ventricular ejection fraction on long-term mortality in patients with heart failure (from the Heart Failure Survey in ISrael). Am J Cardiol 112:1901–1906

    Article  Google Scholar 

  7. Mahjoub H, Rusinaru D, Souliere V, Durier C, Peltier M, Tribouilloy C (2008) Long-term survival in patients older than 80 years hospitalised for heart failure. A 5-year prospective study. Eur J Heart Fail 10:78–84

    Article  Google Scholar 

  8. Holmstrom A, Sigurjonsdottir R, Edner M, Jonsson A, Dahlstrom U, Fu ML (2013) Increased comorbidities in heart failure patients ≥ 85 years but declined from > 90 years: data from the Swedish Heart Failure Registry. Int J Cardiol 167:2747–2752

    Article  Google Scholar 

  9. Tschope C, Birner C, Bohm M, Bruder O, Frantz S, Luchner A et al (2018) Heart failure with preserved ejection fraction: current management and future strategies: expert opinion on the behalf of the nucleus of the “Heart Failure Working Group” of the German Society of Cardiology (DKG). Clin Res Cardiol 107:1–19

    Article  Google Scholar 

  10. Jonsson A, Edner M, Alehagen U, Dahlstrom U (2010) Heart failure registry: a valuable tool for improving the management of patients with heart failure. Eur J Heart Fail 12:25–31

    Article  Google Scholar 

  11. Lam CS, Solomon SD (2014) The middle child in heart failure: heart failure with mid-range ejection fraction (40–50%). Eur J Heart Fail 16:1049–1055

    Article  Google Scholar 

  12. Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF et al (2016) Precipitating clinical factors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction. JACC Heart Fail 4:464–472

    Article  Google Scholar 

  13. Cheng RK, Cox M, Neely ML, Heidenreich PA, Bhatt DL, Eapen ZJ et al (2014) Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population. Am Heart J 168:721–730

    Article  Google Scholar 

  14. MacDonald MR, Wee PP, Cao Y, Yang DM, Lee S, Tong KL et al (2016) Comparison of characteristics and outcomes of heart failure patients with preserved versus reduced ejection fraction in a multiethnic southeast Asian cohort. Am J Cardiol 118:1233–1238

    Article  Google Scholar 

  15. Salamanca-Bautista P, Conde-Martel A, Aramburu-Bodas O, Formiga F, Trullas JC, Quesada-Simon MA et al (2016) Precipitating factors of heart failure admission: differences related to age and left ventricular ejection fraction. Int J Cardiol 219:150–155

    Article  Google Scholar 

  16. Ho JE, Enserro D, Brouwers FP, Kizer JR, Shah SJ, Psaty BM et al (2016) Predicting heart failure with preserved and reduced ejection fraction: the international collaboration on heart failure subtypes. Circ Heart Fail 9:1941–3289

    Article  Google Scholar 

  17. Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade M, Greenberg BH et al (2007) Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF registry. J Am Coll Cardiol 50:768–777

    Article  Google Scholar 

  18. Bauer A, Khalil M, Ludemann M, Bauer J, Esmaeili A, De-Rosa R et al (2018) Creation of a restrictive atrial communication in heart failure with preserved and mid-range ejection fraction: effective palliation of left atrial hypertension and pulmonary congestion. Clin Res Cardiol 107:845–857

    Article  Google Scholar 

  19. Farmakis D, Simitsis P, Bistola V, Triposkiadis F, Ikonomidis I, Katsanos S et al (2017) Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome. Clin Res Cardiol 106:359–368

    Article  Google Scholar 

  20. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A et al (2006) Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med 355:260–269

    Article  CAS  Google Scholar 

  21. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251–259

    Article  CAS  Google Scholar 

  22. Tribouilloy C, Rusinaru D, Mahjoub H, Souliere V, Levy F, Peltier M et al (2008) Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study. Eur Heart J 29:339–347

    Article  Google Scholar 

  23. Cohn JN, Johnson G (1990) Heart failure with normal ejection fraction. The V-HeFT study. Veterans administration cooperative study group. Circulation 81:48–53

    Google Scholar 

  24. Ghali JK, Kadakia S, Bhatt A, Cooper R, Liao Y (1992) Survival of heart failure patients with preserved versus impaired systolic function: the prognostic implication of blood pressure. Am Heart J 123:993–997

    Article  CAS  Google Scholar 

  25. Kontogeorgos S, Thunstrom E, Johansson MC, Fu M (2017) Heart failure with preserved ejection fraction has a better long-term prognosis than heart failure with reduced ejection fraction in old patients in a 5-year follow-up retrospective study. Int J Cardiol 232:86–92

    Article  Google Scholar 

Download references

Funding

This study is supported by the Swedish Heart–Lung Foundation, the Swedish agreement between the government and the county councils concerning economic support for providing an infrastructure for research and education of doctors (ALF) and the Regional Development Fund, Västra Götaland County, Sweden (FOU-VGR).

Author information

Author notes

  1. Xiaojing Chen, Gianluigi Savarese equally contributed as first author. Lars H. Lund, Michael Fu equally contributed as last author.

Authors and Affiliations

  1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Xiaojing Chen

  2. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Xiaojing Chen & Michael Fu

  3. Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden

    Gianluigi Savarese

  4. Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

    Ulf Dahlström & Lars H. Lund

  5. Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden

    Lars H. Lund

Authors
  1. Xiaojing Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gianluigi Savarese
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ulf Dahlström
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lars H. Lund
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiaojing Chen.

Ethics declarations

Conflict of interest

Xiaojing Chen: none. Gianluigi Savarese: none relevant for the present work. Unrelated to the present work: Research funding from the Italian Society of Cardiology on behalf of MSD Italia-Merck Sharp & Dohme Corporation; travel grants from Heart and Lung Foundation. Ulf Dahlström: none. Lars H. Lund: research grants to author’s institution: AstraZeneca, Novartis, Boston Scientiifc; speaker’s honoraria: AstraZeneca, Novartis, StJude, Merck; consulting honoraria: AstraZeneca, Novartis, Sanofi, Bayer, Vifor Pharma, Relypsa, Merck, HeartWare. Micheal Fu: none relevant for the present work. Unrelated to the present work: research funding and/or honoraria from AstraZeneca, Novartis, TRIOMED, and SERVIER.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 40 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, X., Savarese, G., Dahlström, U. et al. Age-dependent differences in clinical phenotype and prognosis in heart failure with mid-range ejection compared with heart failure with reduced or preserved ejection fraction. Clin Res Cardiol 108, 1394–1405 (2019). https://doi.org/10.1007/s00392-019-01477-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-019-01477-z

Keywords

Search

Navigation