Heart Failure With Normal Ejection Fraction

A Growing Pandemic

Satnam Singh; Michael Frenneaux


Future Cardiol. 2012;8(3):383-392. 

In This Article

Scale of the Problem

HFNEF is a major public health problem in the western world, currently representing approximately half of all the patients with HF.[2] HFNEF syndrome has risen to the level of a global pandemic probably because we are diagnosing more HFNEF patients with the help of modern imaging techniques and/or because the patients are living longer.[2] It is especially common in elderly people with comorbid conditions such as hypertension, diabetes, obesity and coronary artery disease.[3]

HFNEF also occurs as a result of restrictive, hypertrophic and infiltrative cardiomyopathies. HFNEF can be quite disabling, severely reducing a patient's quality of life, causing similar symptomatic impairment and is often associated with similar rates of hospitalization as 'systolic HF'. Zile et al. demonstrated that the annual death rate in a HFNEF cohort was approximately 5.2%, with cardiovascular cause of death being the most common.[4] Hospitalization rates are similar when compared with HF with reduced ejection fraction.[5,6] It consumes approximately 1% of the National Health Service budget in the UK.[101]

Symptoms of HFNEF may be precipitated or exacerbated by concomitant anemia, pulmonary disease, renal insufficiency and atrial fibrillation.[7]

In contrast to the advances in therapy for systolic HF over the past three decades, which have improved mortality rates, no therapies have been proven to reduce mortality in patients with HFNEF (Table 1). Consequently, whereas prognosis for systolic HF was substantially higher than that of HFNEF in the past, more recently the difference in mortality has become modest.

At present, the mainstay of treatment for HFNEF is the control of symptoms and management of underlying comorbidities that predispose to the condition, including hypertension, diabetes, ischemia and arrhythmias. Therapies are only modestly effective at relieving symptoms and ineffective at reducing mortality, therefore, there is an urgent need to develop effective treatment strategies for patients with HFNEF.

In this article we address the current epidemiological trend, pathophysiology and recent advances in management of HFNEF.