|Title||Application of Diagnostic Algorithms for Heart Failure With Preserved Ejection Fraction to the Community.|
|Publication Type||Journal Article|
|Year of Publication||2020|
|Authors||Selvaraj S, Myhre PL, Vaduganathan M, Claggett BL, Matsushita K, Kitzman DW, Borlaug BA, Shah AM|
|Secondary Authors||Solomon SD|
|Journal||JACC Heart Fail|
|Date Published||2020 08|
OBJECTIVES: This study sought to describe characteristics and risk of adverse outcomes associated with the HFPEF and HFA-PEFF scores among participants in the community with unexplained dyspnea.
BACKGROUND: Diagnosing heart failure with preserved ejection fraction (HFpEF) can be challenging. The HFPEF and HFA-PEFF scores have recently been developed to estimate the likelihood that HFpEF is present among patients with unexplained dyspnea.
METHODS: The study included 4,892 ARIC (Atherosclerosis Risk In Communities) study participants 67 to 90 years of age at visit 5 (2011 to 2013) without other common cardiopulmonary causes of dyspnea. Participants were categorized as asymptomatic (76.6%), having known HFpEF (10.3%), and having tertiles of each score among those with ≥moderate, self-reported dyspnea (13.1%). The primary outcome was heart failure (HF) hospitalization or death.
RESULTS: Mean age was 75 ± 5 years, 58% were women, and 22% were black. After a mean follow-up of 5.3 ± 1.2 years, rates of HF hospitalization or death per 1,000 person-years for asymptomatic and known HFpEF were 20.7 (95% confidence interval [CI]: 18.9 to 22.7) and 71.6 (95% CI: 61.6 to 83.3), respectively. Among 641 participants with unexplained dyspnea, rates were 27.7 (95% CI: 18.2 to 42.1), 44.9 (95% CI: 34.9 to 57.7), and 47.3 (95% CI: 36.5 to 61.3) (tertiles of HFPEF score) and 31.8 (95% CI: 20.3 to 49.9), 32.4 (95% CI: 23.4 to 44.9), and 54.3 (95% CI: 43.8 to 67.3) (tertiles of HFA-PEFF score). Participants with unexplained dyspnea and scores above the diagnostic threshold suggested for each algorithm, HFPEF score ≥6 and HFA-PEFF score ≥5, had equivalent risk of HF hospitalization or death compared with known HFpEF. Among those with unexplained dyspnea, 28% had "discordant" findings (only high risk by 1 algorithm), while 4% were high risk by both.
CONCLUSIONS: Participants with unexplained dyspnea and higher HFPEF or HFA-PEFF scores face substantial risks of HF hospitalization or death. A significant fraction of patients are classified discordantly by using both algorithms.
|Alternate Journal||JACC Heart Fail|
|Grant List||HHSN268201700001I / HL / NHLBI NIH HHS / United States |
HHSN268201700002I / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States
R01 HL135008 / HL / NHLBI NIH HHS / United States
R01 HL143224 / HL / NHLBI NIH HHS / United States
UL1 TR002541 / TR / NCATS NIH HHS / United States
R01 HL128526 / HL / NHLBI NIH HHS / United States
R01 HL126638 / HL / NHLBI NIH HHS / United States
U01 HL125205 / HL / NHLBI NIH HHS / United States
U10 HL110262 / HL / NHLBI NIH HHS / United States