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    Discriminating clinical features of heart failure with preserved vs. reduced ejection fraction in the community

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    Authors
    Ho, Jennifer E.
    Gona, Philimon
    Pencina, Michael J.
    Tu, Jack V.
    Austin, Peter C.
    Vasan, Ramachandran S.
    Kannel, William B.
    D'Agostino, Ralph B.
    Lee, Douglas S.
    Levy, Daniel
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2012-07-01
    Keywords
    Age Factors
    Aged
    Aged, 80 and over
    Arrhythmias, Cardiac
    Coronary Disease
    Female
    Heart Failure
    Hospitalization
    Humans
    Male
    Myocardial Ischemia
    Potassium
    Sex Factors
    Stroke Volume
    Ventricular Outflow Obstruction
    Cardiovascular Diseases
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1093/eurheartj/ehs070
    Abstract
    AIMS: Heart failure (HF) is a major public health burden worldwide. Of patients presenting with HF, 30-55% have a preserved ejection fraction (HFPEF) rather than a reduced ejection fraction (HFREF). Our objective was to examine discriminating clinical features in new-onset HFPEF vs. HFREF. METHODS AND RESULTS: Of 712 participants in the Framingham Heart Study (FHS) hospitalized for new-onset HF between 1981 and 2008 (median age 81 years, 53% female), 46% had HFPEF (EF >45%) and 54% had HFREF (EF ≤45%). In multivariable logistic regression, coronary heart disease (CHD), higher heart rate, higher potassium, left bundle branch block, and ischaemic electrocardiographic changes increased the odds of HFREF; female sex and atrial fibrillation increased the odds of HFPEF. In aggregate, these clinical features predicted HF subtype with good discrimination (c-statistic 0.78). Predictors were examined in the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. Of 4436 HF patients (median age 75 years, 47% female), 32% had HFPEF and 68% had HFREF. Distinguishing clinical features were consistent between FHS and EFFECT, with comparable discrimination in EFFECT (c-statistic 0.75). In exploratory analyses examining the traits of the intermediate EF group (EF 35-55%), CHD predisposed to a decrease in EF, whereas other clinical traits showed an overlapping spectrum between HFPEF and HFREF. CONCLUSION: Multiple clinical characteristics at the time of initial HF presentation differed in participants with HFPEF vs. HFREF. While CHD was clearly associated with a lower EF, overlapping characteristics were observed in the middle of the left ventricular EF range spectrum.
    Source
    Eur Heart J. 2012 Jul;33(14):1734-41. Epub 2012 Apr 16. Link to article on publisher's site
    DOI
    10.1093/eurheartj/ehs070
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/46570
    PubMed ID
    22507977
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1093/eurheartj/ehs070
    Scopus Count
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    Population and Quantitative Health Sciences Publications

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