Baseline characteristics of 547 new onset heart failure patients in the PREFERS heart failure study

Cecilia Linde, Mattias Ekström, Maria J Eriksson, Eva Maret, Håkan Wallén, Patrik Lyngå, Ulla Wedén, Carin Cabrera, Ulrika Löfström, Jenny Stenudd, Lars H Lund, Bengt Persson, Hans Persson, Camilla Hage, Stockholm County/Karolinska Institutet 4D heart failure investigators, Cecilia Linde, Mattias Ekström, Maria J Eriksson, Eva Maret, Håkan Wallén, Patrik Lyngå, Ulla Wedén, Carin Cabrera, Ulrika Löfström, Jenny Stenudd, Lars H Lund, Bengt Persson, Hans Persson, Camilla Hage, Stockholm County/Karolinska Institutet 4D heart failure investigators

Abstract

Aim: We present the baseline characteristics of the PREFERS Stockholm epidemiological study on the natural history and course of new onset heart failure (HF) aiming to improve phenotyping focusing on HF with preserved left ventricular ejection fraction (HFpEF) pathophysiology.

Methods and results: New onset HF patients diagnosed in hospital or at outpatient HF clinics were included at five Stockholm hospitals 2015-2018 and characterized by N-terminal pro brain natriuretic peptide (NT-proBNP), biomarkers, echocardiography, and cardiac magnetic resonance imaging (subset). HFpEF [left ventricular ejection fraction (LVEF) ≥ 50%] was compared with HF with mildly reduced LVEF (HFmrEF; LVEF 41-49%) and with HF with reduced LVEF (HFrEF; LVEF ≤ 40%). We included 547 patients whereof HFpEF (n = 137; 25%), HFmrEF (n = 61; 11%), and HFrEF (n = 349; 64%). HFpEF patients were older (76; 70-81 years; median; interquartile range) than HFrEF (67; 58-74; P < 0.001), more often women (49% vs. 30%; P < 0.001), and had significantly higher comorbidity burden. They more often had atrial fibrillation, hypertension, and renal dysfunction. NT-proBNP was lower in HFpEF (896; 462-1645 ng/L) than in HFrEF (1160; 563-2370; P = 0.005). In HFpEF, left ventricular (LV) diameters and volumes were smaller (P < 0.001) and septal and posterior wall thickness and relative wall thickness higher (P < 0.001). E/é ≥ 14 was present in 26% of HFpEF vs. 32% of HFrEF (P = 0.017) and left atrial volume index > 34 mL/m2 in 57% vs. 61% (P = 0.040). HFmrEF patients were intermediary between HFpEF and HFrEF for LV mass, LV volumes, and RV volumes but had the highest proportion of left ventricular hypertrophy and the lowest proportion of elevated E/é.

Conclusions: Phenotype data in new onset HF patients recruited in a broad clinical setting showed that 25% had HFpEF, were older, more often women, and had greater comorbidity burden. PREFERS is well suited to further explore biomarker and imaging components of HFpEF pathophysiology and may contribute to the emerging knowledge of HF epidemiology.

Clinical trial registration: Clinicaltrials.gov identifier: NCT03671122.

Keywords: Diastolic function; Epidemiology; Heart failure; Preserved ejection fraction.

Conflict of interest statement

CL reports consulting fees from AstraZeneca, Roche diagnostics and Bayer and speaker honoraria from Novartis, Astra, Bayer, Medtronic, Impulse Dynamics, and Vifor. CH reports consulting fees from Novartis, AnaCardio, and Roche Diagnostics and speaker and honoraria from MSD, supported by the Swedish Research Council (grant 20180899). HP reports speaker honoraria from Vifor and Novartis. LHL reports personal fees from Merck, grants and personal fees from Vifor‐Fresenius, grants and personal fees from AstraZeneca, personal fees from Bayer, grants from Boston Scientific, personal fees from Pharmacosmos, personal fees from Abbott, personal fees from Medscape, personal fees from Myokardia, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, personal fees from Sanofi, personal fees from Lexicon, and personal fees from Radcliffe cardiology, outside the submitted work. ME reports postdoc grants from Novartis foundation for medical and biological research. PL reports consulting fees from Novartis. No potential conflict of interest was reported by the other authors.

© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Figures

Figure 1
Figure 1
Flow chart of the patents in the PREFERS study. Distribution by HF type. HF, heart failure; HFmrEF, heart failure with mildly reduced left ventricular ejection fraction; HFpEF, heart failure with preserved left ventricular ejection fraction; HFrEF, heart failure with reduced left ventricular ejection fraction; LVEF, left ventricular ejection fraction.
Figure 2
Figure 2
Percentage of patients with the most common comorbidities divided by HF type displayed by sex (female patients n = 192, male patients n = 355). Men are represented in blue and women in red. HF, heart failure; HFmrEF, heart failure with mildly reduced left ventricular ejection fraction; HFpEF, heart failure with preserved left ventricular ejection fraction; HFrEF, heart failure with reduced left ventricular ejection fraction; LVEF, left ventricular ejection fraction.

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