Abstract 15840: Clinical Predictors of Heart Failure with Preserved vs Reduced Ejection Fraction: Data from the Framingham Heart Study
Background: Heart failure (HF) is a major growing public health burden in the US. Of patients presenting with HF, 30–55% are estimated to have HF with preserved, rather than reduced ejection fraction (HFPEF vs HFREF). We sought to evaluate clinical risk factors that might classify patients with new-onset HF into HFREF vs HFPEF, a distinction that may have important therapeutic implications when cardiac imaging is not immediately available.
Methods: We examined clinical, laboratory, and EKG characteristics of Framingham Heart Study original and offspring cohort participants, who were hospitalized for initial HF event between 1981–2008. Left ventricular EF was determined by echocardiogram or ventriculogram, and HF was classified as HFPEF (>45%) or HFREF (<=45%). Age-/sex-adjusted models, and multivariate logistic regression were used to discriminate between persons with HFPEF vs HFREF based on clinical determinants at presentation.
Results: Of 986 participants with initial HF hospitalization, 834 underwent evaluation of LVEF, and 712 had non-missing covariates. HFPEF occurred in 46%, and HFREF in 54%. Participants with HFPEF were more likely to be female and have atrial fibrillation, and those with HFREF were more likely to have a history of coronary heart disease (CHD), left bundle branch block (LBBB), and ischemic EKG changes. In a multivariable model, female sex, CHD, heart rate, potassium level, atrial fibrillation, LBBB, and ischemic EKG changes were distinguishing features of HFPEF vs HFREF (see Table). The final risk prediction model had good discrimination (C-statistic 0.78) and calibration (Hosmer-Lemeshow chi-square statistic 7.46, p=0.49).
Conclusions: Clinical characteristics on HF presentation differed in many regards in participants with HFPEF vs HFREF. These distinctions may provide important insights into pathophysiological differences, and may help distinguish HFPEF vs HFREF when cardiac imaging is not immediately available.
- © 2010 by American Heart Association, Inc.