Review Article | Published:

Epidemiology of heart failure with preserved ejection fraction

Nature Reviews Cardiology volume 14, pages 591602 (2017) | Download Citation

Abstract

Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome associated with poor quality of life, substantial health-care resource utilization, and premature mortality. We summarize the current knowledge regarding the epidemiology of HFpEF with a focus on community-based studies relevant to quantifying the population burden of HFpEF. Current data regarding the prevalence and incidence of HFpEF in the community as well as associated conditions and risk factors, risk of morbidity and mortality after diagnosis, and quality of life are presented. In the community, approximately 50% of patients with HF have HFpEF. Although the age-specific incidence of HF is decreasing, this trend is less dramatic for HFpEF than for HF with reduced ejection fraction (HFrEF). The risk of HFpEF increases sharply with age, but hypertension, obesity, and coronary artery disease are additional risk factors. After adjusting for age and other risk factors, the risk of HFpEF is fairly similar in men and women, whereas the risk of HFrEF is much lower in women. Multimorbidity is common in both types of HF, but slightly more severe in HFpEF. A majority of deaths in patients with HFpEF are cardiovascular, but the proportion of noncardiovascular deaths is higher in HFpEF than HFrEF.

Key points

  • In the community, approximately 50% of patients with the clinical syndrome of heart failure (HF) have a preserved ejection fraction (HFpEF)

  • The latest data suggest that the age-specific incidence of HF might be decreasing, but less so in HFpEF than in HF with reduced ejection fraction (HFrEF)

  • The risk of HFpEF increases sharply with age; additional risk factors for the development of HFpEF include hypertension, obesity, and coronary artery disease

  • After adjusting for age and other risk factors, the risk of HFpEF is fairly similar in men and women; however, the risk of HFrEF is much lower in women than men

  • Multimorbidity is common in both types of HF, but slightly more severe in HFpEF, in which approximately 50% of patients have five or more major comorbidities

  • The majority of deaths in patients with HFpEF are cardiovascular, but the proportion of noncardiovascular deaths is higher in HFpEF than HFrEF

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Acknowledgements

S.M.D. is funded through an NIH K23 (K23 HL116643). M.M.R. is funded by the Mayo Foundation and the NIH (U10 HL 110262 and RO1 HL 105418).

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Affiliations

  1. Department of Cardiovascular Disease, Division of Circulatory Failure, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.

    • Shannon M. Dunlay
    • , Véronique L. Roger
    •  & Margaret M. Redfield
  2. Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.

    • Shannon M. Dunlay
    •  & Véronique L. Roger

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S.M.D. and M.M.R. researched data for the article, discussed its content, and wrote the manuscript. All the authors reviewed/edited the article before submission.

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The authors declare no competing financial interests.

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Correspondence to Margaret M. Redfield.

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