Clinical Profile of HFpEF Patients in Primary Care Deciphered

Pavankumar Kamat

September 13, 2021

A new study published in  BJGP Open  highlights the clinical characteristics of patients with heart failure with preserved ejection fraction (HFpEF) managed in UK primary care. Multimorbidity, functional impairment, frailty and polypharmacy were frequently seen in patients with HFpEF.

Although HFpEF accounts for ~50% of all HF cases (~70% in individuals aged >65 years), the condition remains inadequately researched, diagnosed, managed in the primary care setting. This is primarily due to a lack of awareness regarding the condition and ambiguity surrounding its pathophysiology, treatment, and diagnostic criteria. Patients with HFpEF are often not referred to specialist HF services in the UK due to commissioning restrictions.

Researchers conducted a longitudinal cohort study involving patients with suspected HFpEF
identified from 30 general practices in East of England and Oxfordshire/Thames Valley.  

Of the 152 eligible patients were recruited from HF registers, 93 (61%) had clinically confirmed HFpEF. Patients with HFpEF had a mean age of 79.3±7.1 years, 46% were female and 60% had a smoking history. The mean Charlson Comorbidity Index was 4.8. The most common comorbidities included hypertension (80%), moderate to severe kidney disease (33%), diabetes (29%) and chronic lung disease (29%). Mild cognitive impairment was evident in 63% of patients.

Patients with HFpEF were more likely to be overweight/obese (P=.036), pre-frail/frail (P=.033), functionally impaired as evidenced by mean 6-minute walk distance (P=.007) and mean gait speed (P=.010), and less physically active (P=.018) compared with non-HFpEF patients. Polypharmacy was common in patients with HFpEF, with 37% taking ≥10 medications. Fewer patients sought cardiac rehabilitation compared with pharmacological treatment.

The authors stated: "These findings highlight the need to recognise and record HFpEF as a diagnosis, which would enable clinicians to identify patients and work together to optimise well-being through comorbidity management, medication rationalisation, rehabilitation, and self-management."

Forsyth F, Brimicombe J, Cheriyan J, Edwards D, Hobbs R, Jalaludeen N, Mant J, Pilling M, Schiff R, Taylor C, Zaman MJ, Deaton C. Characteristics of patients with heart failure with preserved ejection fraction in primary care: Cross-sectional analysis. BJGP Open. 2021 Aug 31 [Epub ahead of print]. doi: 10.3399/BJGPO.2021.0094. PMID: 34465577

This article originally appeared on Univadis, part of the Medscape Professional Network.

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