From the Guidelines
The progression rate of heart failure with preserved ejection fraction (HFpEF) varies considerably among patients, typically advancing at a rate of 10-20% worsening in functional capacity per year without appropriate management. HFpEF generally progresses more slowly than heart failure with reduced ejection fraction, with annual hospitalization rates of approximately 15-20% and a 5-year mortality rate of 30-50% 1. The disease trajectory is characterized by periods of stability interrupted by acute decompensation events, with each hospitalization accelerating the overall decline. Progression is influenced by several factors including age, comorbidities (particularly hypertension, diabetes, obesity, and atrial fibrillation), symptom severity at diagnosis, and treatment adherence. Patients with multiple comorbidities typically experience faster deterioration.
Key Factors Influencing Progression
- Age: Older patients tend to have a faster progression of HFpEF 1
- Comorbidities: Presence of hypertension, diabetes, obesity, and atrial fibrillation can accelerate disease progression 1
- Symptom severity at diagnosis: Patients with more severe symptoms at diagnosis tend to have a poorer prognosis 1
- Treatment adherence: Adherence to treatment plans can significantly slow disease progression 1 Early diagnosis and aggressive management of both HFpEF and its underlying conditions can significantly slow progression. Treatment focusing on blood pressure control, volume management, exercise, and addressing comorbidities is essential for modifying the disease course, as currently there are no therapies that specifically target the underlying pathophysiology of HFpEF with the same efficacy as treatments for reduced ejection fraction heart failure 1.
From the Research
Rate of Progression of Heart Failure with Preserved Ejection Fraction (HFpEF)
- The proportion and hospitalization rate of patients with HFpEF are increasing steadily relative to patients with heart failure with reduced ejection fraction (HFrEF) 2.
- The incidence of HFpEF has increased by 45% due to improved characterization and diagnostic tools, as well as the increasing prevalence of medical conditions associated with an aging population 3.
- HFpEF has a poor prognosis, comparable to that of HFrEF, with a 5-year survival rate after a first episode of 43% and a high excess mortality compared to the general population 4.
- The rate of progression of HFpEF is influenced by various factors, including age, medical conditions, and lifestyle risk factors, which contribute to a sustained low-grade proinflammatory state that accelerates disease progression 2.
- Comorbidities, such as diabetes, chronic obstructive pulmonary disease, and cancer, are also important predictors of mortality in patients with HFpEF 4.
Factors Affecting the Rate of Progression
- Age-related, medical, and lifestyle risk factors contribute to the development of HFpEF and influence its rate of progression 2.
- Comorbidities, such as hypertension, diabetes, and chronic kidney disease, play a crucial role in the progression of HFpEF 5, 6.
- The use of certain medications, such as chlorthalidone, may reduce the risk of HFpEF and HFREF, while others, such as amlodipine and doxazosin, may have a less favorable effect 6.
Clinical Implications
- The increasing prevalence and poor prognosis of HFpEF highlight the need for early diagnosis and effective treatment strategies 3, 4.
- A comprehensive approach to managing HFpEF, including lifestyle modifications, rigorous control of comorbid conditions, and careful selection of medications, is essential to slow the rate of progression and improve patient outcomes 2, 5.