ESC Heart Failure (Feb 2025)

Prognosis of early‐stage HFpEF in the community‐dwelling elderly: The Northern Shanghai Study

  • Weilun Meng,
  • Haotian Yang,
  • Zhongyuan Ren,
  • Jiawen Wu,
  • Yixing Zheng,
  • Song Zhao,
  • Chong Xu,
  • Rusitanmujiang Maimaitiaili,
  • Jiamin Tang,
  • Shikai Yu,
  • Jing Xiong,
  • Chen Chi,
  • Yawei Xu,
  • Yi Zhang

DOI
https://doi.org/10.1002/ehf2.15060
Journal volume & issue
Vol. 12, no. 1
pp. 229 – 238

Abstract

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Abstract Objective Heart failure with preserved ejection fraction (HFpEF) is a growing concern among the elderly population, significantly impacting morbidity and mortality rates. This study aimed to screen and investigate the characteristics and prognosis of early‐stage HFpEF in the elderly. Methods A total of 1789 community‐dwelling individuals aged over 65 from northern Shanghai were enrolled. According to American Heart Association (AHA) guidelines, participants were classified into four groups: HFpEF stage 0, HFpEF stage A, HFpEF stage B and HFpEF stage C. Major endpoints included major adverse cardiovascular events (MACEs), all‐cause death and cardiovascular death. Results After a mean follow‐up period of 7.10 ± 1.27 years, 1623 elderly subjects were included [HFpEF stage 0 (10.3%), HFpEF stage A (16.3%), HFpEF stage B (60.6%) and HFpEF stage C (12.8%)]. Patients with HFpEF stage A, HFpEF stage B and HFpEF stage C exhibited more MACEs than those in HFpEF stage 0 (P < 0.01). Patients with HFpEF stage C had a significantly higher cardiovascular (P < 0.001) and all‐cause death ratio (P < 0.01). With HFpEF stage 0 as a reference, the increases in MACEs were significantly associated with HFpEF stage A [hazard ratio (HR): 2.97, 95% confidence interval (CI) (1.13, 7.82), P < 0.05], HFpEF stage B [HR: 2.69, 95% CI (1.09, 6.64), P < 0.05] and HFpEF stage C [HR: 4.86, 95% CI (1.88, 12.59), P < 0.01] in the Cox regression analysis. Our finding remains unaltered in the sensitivity analysis, with no interaction for effectiveness. Conclusions Compared with those with HFpEF stage 0, patients with HFpEF, whether in stage B or C, exhibit significantly higher cardiovascular and all‐cause mortality in the elderly. This study underscores the importance of early‐stage HFpEF screening, particularly in older, asymptomatic stage B individuals.

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