Characteristics of patients with heart failure with preserved ejection fraction in primary care: a cross-sectional analysis

OPTIMISE HFpEF investigators and collaborators, Faye Forsyth, James Brimicombe, Joseph Cheriyan, Duncan Edwards, F. D.Richard Hobbs, Navazh Jalaludeen, Jonathan Mant, Mark Pilling, Rebekah Schiff, Clare J. Taylor, M Justin Zaman, Christi Deaton*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: Many patients with heart failure with preserved ejection fraction (HFpEF) are undiagnosed, and UK general practice registers do not typically record heart failure (HF) subtype. Improvements in management of HFpEF is dependent on improved identification and characterisation of patients in primary care.

Aim: To describe a cohort of patients recruited from primary care with suspected HFpEF and compare patients in whom HFpEF was confirmed and refuted.

Design & setting: Baseline data from a longitudinal cohort study of patients with suspected HFpEF recruited from primary care in two areas of England.

Method: A screening algorithm and review were used to find patients on HF registers without a record of reduced ejection fraction (EF). Baseline evaluation included cardiac, mental and physical function, clinical characteristics, and patient reported outcomes. Confirmation of HFpEF was clinically adjudicated by a cardiologist.

Results: In total, 93 (61%) of 152 patients were confirmed HFpEF. The mean age of patients with HFpEF was 79 years, 46% were female, 80% had hypertension, and 37% took ≥10 medications. Patients with HFpEF were more likely to be obese, pre-frail or frail, report more dyspnoea and fatigue, were more functionally impaired, and less active than patients in whom HFpEF was refuted. Few had attended cardiac rehabilitation.

Conclusion: Patients with confirmed HFpEF had frequent multimorbidity, functional impairment, frailty, and polypharmacy. Although comorbid conditions were similar between people with and without HFpEF, the former had more obesity, symptoms, and worse physical function. These findings highlight the potential to optimise wellbeing through comorbidity management, medication rationalisation, rehabilitation, and supported self-management.

Original languageEnglish
Article numberBJGPO.2021.0094
Number of pages12
JournalBJGP Open
Volume5
Issue number6
DOIs
Publication statusPublished - 10 Nov 2021

Bibliographical note

Funding Information:
This work was supported by the National Institute for Health Research School for Primary Care Research (NIHR SPCR) (grant number: 384), the NIHR Cambridge Biomedical Research Centre (reference number: BRC-1215–20014), and conducted at and supported by the NIHR Cambridge Clinical Research Facility. The views expressed are those of the authors and not necessarily those of the NIHR, the NHS, or the Department of Health and Social Care. The study sponsors were not involved in any aspect of the study including study design, data collection, data analysis, and interpretation of data. Clare J Taylor is funded by an NIHR academic clinical lectureship. FD Richard Hobbs acknowledges part-funding from the NIHR SPCR, the NIHR Collaboration for Leadership in Health Research and Care Oxford, the NIHR Oxford Biomedical Research Centre, and the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative. Christi Deaton has funding from NIHR, NIHR SPCR, and Adden-brookes Charitable Trust. Jonathan Mant is an NIHR Senior Investigator.

Publisher Copyright:
© 2021, The Authors

Keywords

  • Frailty
  • Heart failure with preserved ejection fraction
  • Multimorbidity
  • Primary health care

ASJC Scopus subject areas

  • Family Practice

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