Identification of distinct phenotypic clusters in heart failure with preserved ejection fraction
-
- Alicia Uijl
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
-
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine Karolinska Institutet Stockholm Sweden
-
- Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
-
- Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences Linkoping University Linköping Sweden
-
- Jasper J. Brugts
- Department of Cardiology, Thoraxcenter Erasmus MC University Medical Center Rotterdam The Netherlands
-
- Gerard C.M. Linssen
- Department of Cardiology Hospital Group Twente Almelo and Hengelo The Netherlands
-
- Vanessa van Empel
- Department of Cardiology Maastricht University Medical Center Maastricht The Netherlands
-
- Hans‐Peter Brunner‐La Rocca
- Department of Cardiology Maastricht University Medical Center Maastricht The Netherlands
-
- Folkert W. Asselbergs
- Department of Cardiology, Division Heart & Lungs University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
-
- Lars H. Lund
- Division of Cardiology, Department of Medicine Karolinska Institutet Stockholm Sweden
-
- Arno W. Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
-
- Stefan Koudstaal
- Department of Cardiology, Division Heart & Lungs University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
抄録
<jats:sec><jats:title>Aims</jats:title><jats:p>We aimed to derive and validate clinically useful clusters of patients with heart failure with preserved ejection fraction (HFpEF; left ventricular ejection fraction ≥50%).</jats:p></jats:sec><jats:sec><jats:title>Methods and results</jats:title><jats:p>We derived a cluster model from 6909 HFpEF patients from the Swedish Heart Failure Registry (SwedeHF) and externally validated this in 2153 patients from the Chronic Heart Failure ESC‐guideline based Cardiology practice Quality project (CHECK‐HF) registry. In SwedeHF, the median age was 80 [interquartile range 72–86] years, 52% of patients were female and most frequent comorbidities were hypertension (82%), atrial fibrillation (68%), and ischaemic heart disease (48%). Latent class analysis identified five distinct clusters: cluster 1 (10% of patients) were young patients with a low comorbidity burden and the highest proportion of implantable devices; cluster 2 (30%) patients had atrial fibrillation, hypertension without diabetes; cluster 3 (25%) patients were the oldest with many cardiovascular comorbidities and hypertension; cluster 4 (15%) patients had obesity, diabetes and hypertension; and cluster 5 (20%) patients were older with ischaemic heart disease, hypertension and renal failure and were most frequently prescribed diuretics. The clusters were reproduced in the CHECK‐HF cohort. Patients in cluster 1 had the best prognosis, while patients in clusters 3 and 5 had the worst age‐ and sex‐adjusted prognosis.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Five distinct clusters of HFpEF patients were identified that differed in clinical characteristics, heart failure drug therapy and prognosis. These results confirm the heterogeneity of HFpEF and form a basis for tailoring trial design to individualized drug therapy in HFpEF patients.</jats:p></jats:sec>
収録刊行物
-
- European Journal of Heart Failure
-
European Journal of Heart Failure 23 (6), 973-982, 2021-05
Wiley