Heart Failure with Normal Systolic Function: Better or Worse Prognosis?

1. Heart Failure with Normal Systolic Function: Better or Worse Prognosis? Maria Rosa Costanzo, M.D., F.A.C.C, F.A.H.A. Medical Director, Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs Medical Director, Edward Hospital Center for Advanced Heart Failure Naperville, Illinois, U.S.A.

2. Characteristics of Patients with Heart Failure and Normal or Reduced Ejection Fraction Owan TE et al. NEJM 2006; 355:251-9

3. Secular Trends in the Prevalence of Heart Failure with Normal Ejection Fraction Owan T et al. N Engl J Med 2006;355:251-259

4. Secular Trends in Survival among Patients with Heart Failure and Normal or Reduced EF Survival Improved Over Time in Patients with Reduced EF, But Not in Patients with Normal EF Owan T et al. NEJM 2006;355:251-259

5. Association of Clinical Characteristics with Mortality in Patients with Normal versus Reduced EF Owan T et al. NEJM 2006;355:251-259

6. Predictors of Mortality in Patients with HF and Normal Systolic Function in the DIG Trial • GFR • NYHA III/IV • Male gender • Age • Diuretics • BMI • CR Ratio • DM • Vasodilators • K-Sparing Diur. • DBP Jones, R.C. et al. J Am Coll Cardiol 2004;44:1025-1029

7. Survival of Patients with HFNEF and HFREF by Cause HFNEF HFREF Lee, D. S. et al. Circulation 2009;119:3070-7

8. Survival Curves by Etiology of HF with Normal EF Tribouilloy C et al. EHJ 2008;29:339-47

9. Impact of EF on Outcomes after PCI in HF Patients-NHLBI PTCA Registry Holper EM et al. AHJ 2006; 151: 69-75

10. Kaplan–Meier Analysis of the Probability of Survival among 3166 Patients with a Recent AMI Divided by No In-Hospital CHF, HFNEF (CHF+WMI>1.3), and HFREF (CHF+WMI<1.3), and Stratified According to Age. *No CHF vs. HFNEF p= 0.00001  No CHF vs. HFREF p= 0.00001 Møller J E et al. EJHF 2003;5:811-9

11. Prognostic Importance of Pulmonary Hypertension in Patients with HF Kjaergaard J et al. AJC 2007; 99: 1146-50

12. Danciu Sc et al. AJC 2006; 97: 256-9

13. Racial Differences in the O utcomes of Patients with Diastolic HF CAD white AA P = 0.488 NO CAD white AA P = 0.002 East MA et al. AHJ 2004; 148: 151-6

14. Survival Kapoor JR et al. AHJ 2010; 159: 75-80

15. Anemia and Survival in Patients with Reduced and Normal EF Felker MG et al. AHJ 2006; 151: 457-62

16. Risk of Different Outcomes Associated with Diabetes in HFREF and HFNEF MacDonald M R et al. EHJ 2008;29:1377-85

17. Effect of Severe Autonomic Failure on Outcomes after MI in Patients with Normal LVEF Severe autonomic failure (SAF): combination of severely impaired baroreflex function with abnormal autonomic tone, assessed by Heart Rate Turbulence (HRT) and cardiac Deceleration Capacity (DC). Bauer A et al. EHJ 2009; 30:576-83

18. BNP Predicts Medium-Term Risk in Patients with Acute HF and Normal EF BNP Levels 434 P< 0.05 278 Pg/mL 80 Valle R et al. JCF 2005; 11: 498-503

19. P < 0.0001 P < 0.0001 P < 0.004 P < 0.0001 P < 0.0009 P = 0.0003 % P < 0.0001 P < 0.0001 Fonarow GC et al. JACC2007; 50: 767-77

20. Effects of Ibersartan in Patients with HFNEF Massie B et al. N Engl J Med 2008;359:2456-2467

21. * P = 0.001 vs. prior year % of Patients * * * * EF Massie BM et al. AJC 2007; 99: 1263-8

22. Effect of Beta Blockers on Survival in Patients with Advanced HF and Normal EF Dobre D et al. EJHF 2007;9:280-6

23. Conclusions • The prevalence of HFNEF is increasing • Hospitalizations for ADHF in patients with HFNEF are increasing • The outcomes of HFNEF and HFREF are similar • The outcomes of patients with HFNEF are determined by the presence and severity of comorbidities • With the exception of BB, other therapies which improve the outcomes of patients with HFREF do not significantly alter morbidity and mortality of patients with HFNEF