Epidemiology of Diastolic Heart Failure

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Heart failure (HF) is a major public health problem. Clinical studies suggest that a significant proportion of patients with HF have preserved ejection fraction, a clinical syndrome commonly referred to as diastolic HF (DHF). One of the purposes of epidemiological studies is to identify unmet public health needs in a population and to quantify the magnitude of the problem in a manner that is free from the referral bias inherent in clinical studies. We review current epidemiological data estimating the prevalence of DHF, highlight the challenges posed by existing data, and suggest focus for future studies on the epidemiology of DHF. We limited the review to studies that met our definition of population-based studies (eg, studies drawing participants from a defined community or all consecutive referrals to a health facility that is the sole provider to a defined community). Studies relevant to the epidemiology of each stage of DHF (American College of Cardiology/American Heart Association stages A-D) were reviewed. These epidemiological studies clearly define the magnitude of this health care problem and underscore the urgent need for studies elucidating the natural history, pathophysiology, and optimal diagnostic and management strategy for this extremely common clinical syndrome.

Section snippets

Risk Factors Associated With DHF (Stage A DHF)

To establish causality, studies that evaluate the temporal relationships between putative risk factors and disease or outcome of interest are required. Prevalence studies can only give information on conditions associated with a given disease. Over the past 5 decades, data from longitudinal studies such as the Framingham Heart Study have identified both traditional and emerging risk factors for HF. Whether the syndromes of SHF and DHF are the result of the similar pathophysiological pathways

Prevalence of Preclinical Diastolic Dysfunction (Stage B DHF)

It is assumed that primary abnormalities in diastolic function are the key factors responsible for the clinical signs and symptoms of DHF. As profound reduction in systolic function can exist in the absence of clinically overt HF, it is assumed that diastolic dysfunction may also be present in asymptomatic individuals. Definitive invasive characterization of diastolic function should include assessment of the speed and extent of left ventricular relaxation, a measurement that requires placement

Prevalence of DHF Among Patients With Clinically Overt HF

The reported prevalence of DHF among patients with clinically overt HF varies widely and is influenced by a number of factors including the characteristics of the population studied, choice of imaging modality, the criteria used to diagnose HF, whether incident and/or prevalent HF cases are studied, whether patients with HF diagnosed in the outpatient setting are included, and the cutoff values for defining systolic dysfunction. In clinical series, the frequency of DHF among patients with HF

Population Prevalence of Overt DHF (Stages C-D DHF)

The age-stratified prevalence of clinical HF has been defined in a number of studies from Europe and the United States. Age-specific prevalence data from some of these studies are summarized in Fig 5A-C. These previous studies on the prevalence of clinically defined HF in various populations are presented to provide context for the more recent epidemiological studies that have defined the prevalence of HF, the prevalence of DHF among those with HF, and the population prevalence of DHF as

Mortality Associated With a Diagnosis of DHF or SHF in Population-Based Studies

The population prevalence of DHF is also dependent on how long patients are surviving with the condition. Whether patients survive longer after a diagnosis of DHF than after a diagnosis of SHF is still debated.31 Four population-based studies have compared mortality in DHF vs SHF (Fig 6). In the study of Senni et al36 (Fig 6A), unadjusted survival and survival adjusted for age, sex, NYHA class, and the presence of coronary artery disease were not different between those with SHF and those with

Summary

The studies reviewed here confirm that all stages of DHF are common among varying populations across the globe. Studies in the United States are limited by an underrepresentation of black and Hispanic persons; worldwide, only fairly developed nations have been studied. There are no large data sets that clearly define the age- and sex-specific prevalence of HF, DHF, and SHF within diverse populations. Although significant limitations exist for each study, findings are remarkably consistent

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