Application of Diagnostic Algorithms for Heart Failure With Preserved Ejection Fraction to the Community.

TitleApplication of Diagnostic Algorithms for Heart Failure With Preserved Ejection Fraction to the Community.
Publication TypeJournal Article
Year of Publication2020
AuthorsSelvaraj S, Myhre PL, Vaduganathan M, Claggett BL, Matsushita K, Kitzman DW, Borlaug BA, Shah AM
Secondary AuthorsSolomon SD
JournalJACC Heart Fail
Volume8
Issue8
Pagination640-653
Date Published2020 08
ISSN2213-1787
Abstract

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.

DOI10.1016/j.jchf.2020.03.013
Alternate JournalJACC Heart Fail
PubMed ID32535127
Grant ListHHSN268201700001I / 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