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J Am Coll Cardiol. 2014 Dec 2;64(21):2281-93. doi: 10.1016/j.jacc.2014.08.036. Epub 2014 Nov 24.

Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction.

Author information

1
Duke University, Durham, North Carolina. Electronic address: robert.mentz@duke.edu.
2
Duke University, Durham, North Carolina.
3
Oslo University Hospital Ulleval, University of Oslo, and Institute of Clinical Sciences, University of Oslo, Oslo, Norway.
4
University of Groningen, Groningen, the Netherlands.
5
Framingham Heart Study, Framingham, Boston University School of Medicine, Boston, Massachusetts.
6
National Heart and Lung Institute, Imperial College and Imperial College London, Royal Brompton Hospital, London, United Kingdom.
7
Copenhagen University Hospital (Rigshospitalet), Copenhagen, and Aalborg University, Aalborg, Denmark.
8
Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
9
Emory University, Atlanta, Georgia.
10
INSERM, Centre d'Investigations Cliniques, Université de Lorraine and CHU de Nancy, Nancy, France.
11
University of Michigan School of Medicine, Ann Arbor, Michigan.

Abstract

Heart failure patients are classified by ejection fraction (EF) into distinct groups: heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). Although patients with heart failure commonly have multiple comorbidities that complicate management and may adversely affect outcomes, their role in the HFpEF and HFrEF groups is not well-characterized. This review summarizes the role of noncardiac comorbidities in patients with HFpEF versus HFrEF, emphasizing prevalence, underlying pathophysiologic mechanisms, and outcomes. Pulmonary disease, diabetes mellitus, anemia, and obesity tend to be more prevalent in HFpEF patients, but renal disease and sleep-disordered breathing burdens are similar. These comorbidities similarly increase morbidity and mortality risk in HFpEF and HFrEF patients. Common pathophysiologic mechanisms include systemic and endomyocardial inflammation with fibrosis. We also discuss implications for clinical care and future HF clinical trial design. The basis for this review was discussions between scientists, clinical trialists, and regulatory representatives at the 10th Global CardioVascular Clinical Trialists Forum.

KEYWORDS:

comorbidities; ejection fraction; heart failure

PMID:
25456761
PMCID:
PMC4254505
DOI:
10.1016/j.jacc.2014.08.036
[Indexed for MEDLINE]
Free PMC Article

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