Diastolic heart failure in the community: Clinical profile, natural history, therapy, and impact of proposed diagnostic criteria

Horng Haur Chen, John G. Lainchbury, Michele Senni, Kent R Bailey, Margaret May Redfield

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

Background: Diastolic heart failure (DHF) has been broadly defined as "signs and symptoms of congestive heart failure (CHF) with normal/near normal systolic function." The clinical profile and natural history of the syndrome remain controversial. Furthermore, the frequency with which patients with CHF and normal ejection fraction (EF) fulfill recently proposed standardized diagnostic criteria for DHF is unclear. Our objective was to determine the clinical profile, Doppler echocardiographic features, current management, prognosis, and predictors of outcome of all patients with new onset CHF who had normal EF in Olmsted County, Minnesota, during 1996-1997. The frequency with which patients met recently proposed standardized criteria for diagnosis of DHF was assessed. Methods: Using the resources of the Rochester Epidemiology Project, all residents of Olmsted County, Minnesota, with a new diagnosis of CHF in 1996-1997, an ejection fraction >45%, and no valve disease (n = 83) were identified. Results: Patients were elderly (79 ± 13 yr), predominately female (76%), and had hypertension and/or coronary artery disease (85%). New-onset atrial fibrillation, ischemia, and medical comorbidities were frequently present at diagnosis. Although most patients (81%) met criteria for "probable DHF" by recently proposed clinical criteria, only half of patients met European criteria in which evidence of abnormal function/filling is required. The 1-, 2-, and 3-year mortality rates were 29%, 39%, and 60%, respectively. Angiotensin-converting enzyme inhibition (P = .0008) and β-blocker (P = .02) therapy were independently associated with improved survival. Conclusion: This population-based study provides a comprehensive clinical profile, current management, prognosis, and predictors of outcome of patients with new onset CHF who had normal ejection fraction.

Original languageEnglish (US)
Pages (from-to)279-287
Number of pages9
JournalJournal of Cardiac Failure
Volume8
Issue number5
DOIs
StatePublished - Oct 2002

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Diastolic Heart Failure
Natural History
Heart Failure
Therapeutics
Peptidyl-Dipeptidase A
Atrial Fibrillation
Signs and Symptoms
Comorbidity
Coronary Artery Disease
Epidemiology
Ischemia
Hypertension
Survival
Mortality

Keywords

  • Doppler echocardiography
  • Heart failure with preserved systolic function
  • Left ventricular function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{ba00feaf738e47278a9dfcb109f7eab9,
title = "Diastolic heart failure in the community: Clinical profile, natural history, therapy, and impact of proposed diagnostic criteria",
abstract = "Background: Diastolic heart failure (DHF) has been broadly defined as {"}signs and symptoms of congestive heart failure (CHF) with normal/near normal systolic function.{"} The clinical profile and natural history of the syndrome remain controversial. Furthermore, the frequency with which patients with CHF and normal ejection fraction (EF) fulfill recently proposed standardized diagnostic criteria for DHF is unclear. Our objective was to determine the clinical profile, Doppler echocardiographic features, current management, prognosis, and predictors of outcome of all patients with new onset CHF who had normal EF in Olmsted County, Minnesota, during 1996-1997. The frequency with which patients met recently proposed standardized criteria for diagnosis of DHF was assessed. Methods: Using the resources of the Rochester Epidemiology Project, all residents of Olmsted County, Minnesota, with a new diagnosis of CHF in 1996-1997, an ejection fraction >45{\%}, and no valve disease (n = 83) were identified. Results: Patients were elderly (79 ± 13 yr), predominately female (76{\%}), and had hypertension and/or coronary artery disease (85{\%}). New-onset atrial fibrillation, ischemia, and medical comorbidities were frequently present at diagnosis. Although most patients (81{\%}) met criteria for {"}probable DHF{"} by recently proposed clinical criteria, only half of patients met European criteria in which evidence of abnormal function/filling is required. The 1-, 2-, and 3-year mortality rates were 29{\%}, 39{\%}, and 60{\%}, respectively. Angiotensin-converting enzyme inhibition (P = .0008) and β-blocker (P = .02) therapy were independently associated with improved survival. Conclusion: This population-based study provides a comprehensive clinical profile, current management, prognosis, and predictors of outcome of patients with new onset CHF who had normal ejection fraction.",
keywords = "Doppler echocardiography, Heart failure with preserved systolic function, Left ventricular function",
author = "Chen, {Horng Haur} and Lainchbury, {John G.} and Michele Senni and Bailey, {Kent R} and Redfield, {Margaret May}",
year = "2002",
month = "10",
doi = "10.1054/jcaf.2002.128871",
language = "English (US)",
volume = "8",
pages = "279--287",
journal = "Journal of Cardiac Failure",
issn = "1071-9164",
publisher = "Churchill Livingstone",
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}

TY - JOUR

T1 - Diastolic heart failure in the community

T2 - Clinical profile, natural history, therapy, and impact of proposed diagnostic criteria

AU - Chen, Horng Haur

AU - Lainchbury, John G.

AU - Senni, Michele

AU - Bailey, Kent R

AU - Redfield, Margaret May

PY - 2002/10

Y1 - 2002/10

N2 - Background: Diastolic heart failure (DHF) has been broadly defined as "signs and symptoms of congestive heart failure (CHF) with normal/near normal systolic function." The clinical profile and natural history of the syndrome remain controversial. Furthermore, the frequency with which patients with CHF and normal ejection fraction (EF) fulfill recently proposed standardized diagnostic criteria for DHF is unclear. Our objective was to determine the clinical profile, Doppler echocardiographic features, current management, prognosis, and predictors of outcome of all patients with new onset CHF who had normal EF in Olmsted County, Minnesota, during 1996-1997. The frequency with which patients met recently proposed standardized criteria for diagnosis of DHF was assessed. Methods: Using the resources of the Rochester Epidemiology Project, all residents of Olmsted County, Minnesota, with a new diagnosis of CHF in 1996-1997, an ejection fraction >45%, and no valve disease (n = 83) were identified. Results: Patients were elderly (79 ± 13 yr), predominately female (76%), and had hypertension and/or coronary artery disease (85%). New-onset atrial fibrillation, ischemia, and medical comorbidities were frequently present at diagnosis. Although most patients (81%) met criteria for "probable DHF" by recently proposed clinical criteria, only half of patients met European criteria in which evidence of abnormal function/filling is required. The 1-, 2-, and 3-year mortality rates were 29%, 39%, and 60%, respectively. Angiotensin-converting enzyme inhibition (P = .0008) and β-blocker (P = .02) therapy were independently associated with improved survival. Conclusion: This population-based study provides a comprehensive clinical profile, current management, prognosis, and predictors of outcome of patients with new onset CHF who had normal ejection fraction.

AB - Background: Diastolic heart failure (DHF) has been broadly defined as "signs and symptoms of congestive heart failure (CHF) with normal/near normal systolic function." The clinical profile and natural history of the syndrome remain controversial. Furthermore, the frequency with which patients with CHF and normal ejection fraction (EF) fulfill recently proposed standardized diagnostic criteria for DHF is unclear. Our objective was to determine the clinical profile, Doppler echocardiographic features, current management, prognosis, and predictors of outcome of all patients with new onset CHF who had normal EF in Olmsted County, Minnesota, during 1996-1997. The frequency with which patients met recently proposed standardized criteria for diagnosis of DHF was assessed. Methods: Using the resources of the Rochester Epidemiology Project, all residents of Olmsted County, Minnesota, with a new diagnosis of CHF in 1996-1997, an ejection fraction >45%, and no valve disease (n = 83) were identified. Results: Patients were elderly (79 ± 13 yr), predominately female (76%), and had hypertension and/or coronary artery disease (85%). New-onset atrial fibrillation, ischemia, and medical comorbidities were frequently present at diagnosis. Although most patients (81%) met criteria for "probable DHF" by recently proposed clinical criteria, only half of patients met European criteria in which evidence of abnormal function/filling is required. The 1-, 2-, and 3-year mortality rates were 29%, 39%, and 60%, respectively. Angiotensin-converting enzyme inhibition (P = .0008) and β-blocker (P = .02) therapy were independently associated with improved survival. Conclusion: This population-based study provides a comprehensive clinical profile, current management, prognosis, and predictors of outcome of patients with new onset CHF who had normal ejection fraction.

KW - Doppler echocardiography

KW - Heart failure with preserved systolic function

KW - Left ventricular function

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U2 - 10.1054/jcaf.2002.128871

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