Evolution of a Geriatric Syndrome: Pathophysiology and Treatment of Heart Failure With Preserved Ejection Fraction

Bharathi Upadhya, MD; Barbara Pisani, MD; Dalane W. Kitzman, MD


J Am Geriatr Soc. 2017;65(11):2431-2440. 

In This Article

Clinical Significance

Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF in individuals aged 65 and older;[1] in older women, more than 80% of new cases of HF are HFpEF.[2] Nearly all indiviudals aged 90 and older with HF have preserved EF.[3] In contrast to HF with reduced ejection fraction (HFrEF), the prevalence of HFpEF is increasing, and its prognosis is not improving, which may be due to the combination of the aging of the population and increasing rates of obesity.[4] The health and economic effect of HFpEF is at least as great as that of HFrEF.[4,5] The combined mortality and readmission rates 90 days after discharge are comparable with those of HFrEF (35%).[6] One-year mortality for HFpEF ranges up to 29%,[4,7] and is greater with greater burden of comorbidities.[8] Although cardiovascular (CV) events are the most common cause of death, noncardiac causes of death are common and account for a significant proportion of deaths in HFpEF.[9] Individuals with HFpEF have high rehospitalization rates,[6] and the majority of rehospitalizations are for noncardiac causes.[5] In addition, individuals with HFpEF have poor quality of life, similar in severity to that of individuals with HFrEF. AUTHOR: Again, so far it has sounded like HFpEF is more of a problem than HFrEF, but here you say that it is similar in severity of poor quality of life.[10]