Epidemiology of Diastolic Heart Failure
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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