Heart failure with preserved ejection fraction in African Americans: The ARIC (Atherosclerosis Risk In Communities) study

Abstract

Objectives: In an entirely African-American cohort, we compared clinical characteristics, cardiac structure and function, and all-cause mortality in patients with heart failure (HF) with preserved ejection fraction (HFpEF) in relation to patients with heart failure with reduced ejection fraction (HFrEF) and those without HF.

Background: African Americans are at increased risk for HF. Nevertheless, there are limited phenotypic and prognostic data in African Americans with HFpEF compared with those with HFrEF and those without HF.

Methods: Middle-aged African Americans from the Jackson, Mississippi, cohort of the ARIC (Atherosclerosis Risk In Communities) study (n = 2,445) underwent echocardiography between 1993 and 1995. HF prevalence was available in 1,962 patients for whom left ventricular ejection fraction (LVEF) could be quantified. Participants with HF were categorized as having HFpEF (LVEF ≥50%), HFrEF (LVEF <50%), or no HF, with comparisons made between groups.

Results: HF was identified in 116 (5.9%) participants (HFpEF n = 85 [73%]; HFrEF n = 31 [27%]). Compared with those without HF, those with HFpEF were older, were more likely to be female, and had more frequent comorbidities and concentric hypertrophy. In relation to HFrEF, those with HFpEF were more likely to be female but less likely to have coronary heart disease, diabetes mellitus, chronic kidney disease, left atrial enlargement, and eccentric hypertrophy. Over a median 13.7 years of follow-up, risk of death differed between groups, with age- and sex-adjusted hazard ratios of 1.51 (95% confidence interval: 1.01 to 2.25) for HFpEF versus those without HF and 2.50 (95% confidence interval: 1.37 to 4.58) for HFrEF versus HFpEF.

Conclusions: In this cohort of middle-aged African Americans, HFpEF was the most common form of HF and was associated with a substantially better prognosis than HFrEF but worse than those without HF.

Figures

Figure 1. Survival in African-Americans according to heart failure status

Kaplan-Meier survival analysis in those without heart failure (nonHF), heart failure with preserved ejection fraction (HFpEF), and those with heart failure and reduced ejection fraction (HFrEF).

Figure 2. Proportion of deaths due to cardiovascular and non-cardiovascular causes according to heart failure status in African-Americans

Cause of death ascertained from ICD-9 codes. HFpEF = heart failure with preserved ejection fraction, HFrEF = heart failure with reduced ejection fraction, nonHF = no heart failure.