Clinical Trajectory and Risk Stratification for Heart Failure with Preserved Ejection Fraction in a Real-World Cohort of Patients with Suspected Coronary Artery Disease

Guglielmo Gioia; Karl-Patrik Kresoja; Sebastian Rosch; Anne Schöber; Elias Harnisch; Maximilian von Roeder; Markus Scholz; Sylvia Henger; Berend Isermann; Holger Thiele; Philipp Lurz; Karl-Philipp Rommel

doi:10.3390/jcm13072092

Clinical Trajectory and Risk Stratification for Heart Failure with Preserved Ejection Fraction in a Real-World Cohort of Patients with Suspected Coronary Artery Disease

J Clin Med. 2024 Apr 3;13(7):2092. doi: 10.3390/jcm13072092.

Authors

Affiliations

¹ Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany.
² LIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, 04109 Leipzig, Germany.
³ Institute of Medical Informatics, Statistic and Epidemiology, University of Leipzig, 04109 Leipzig, Germany.
⁴ Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, 04103 Leipzig, Germany.
⁵ Department of Cardiology, University Hospital Mainz, 55131 Mainz, Germany.
⁶ Cardiovascular Research Foundation, New York, NY 10019, USA.

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) is a widespread condition with significant morbidity and mortality. Its clinical heterogeneity may delay the diagnosis. Aim: To identify predictors of HFpEF-related hospitalizations in ambulatory patients presenting with elevated cardiovascular risk, suspected coronary artery diseases (CADs), and positive HFpEF screenings. Methods: Consecutive patients presenting with suspected CAD, enrolled in the observational LIFE-Heart study (2006-2014, NCT00497887), and meeting HFpEF criteria per the 2016 European Society of Cardiology (ESC) guidelines were categorized according to the presence of "overlapping conditions" potentially masking or contributing to their symptoms. Additional stratification using the H₂FPEF score (<2: low risk, 2-5: intermediate risk, and ≥6 high risk) was performed. Follow-up for hospitalizations, reasons of hospitalization, and death spanned a median of 6 years. Results: Of 1054 patients (66 ± 10 years, 60% male, NT-pro-BNP 286, IQR 183-574 pg/mL), 53% had overlapping conditions, while 47% had "isolated HFpEF". The H₂FPEF scores classified 23%, 57%, and 20% as low-, intermediate-, and high-risk, respectively, with consistent proportions across patients with and without overlapping conditions (p = 0.91). During the follow-up observational phase, 54% were rehospitalized, 22% experienced heart failure (HF) rehospitalizations, and 11% of patients died. Multivariable logistic regression revealed a high-risk H₂FPEF category as an independent predictor of HF rehospitalization in the overall cohort (odds ratio: 3.4, CI: 2.4-4.9, p < 0.01) as well as in patients with and without overlapping conditions. Furthermore, a H₂FPEF score ≥ 6 was independently associated with higher mortality rates (hazard ratio: 1.8, CI: 1.2-2.6, p < 0.01) in the Cox regression analysis. Conclusions: Ambulatory patients presenting for suspected CAD and meeting HFpEF screening criteria face elevated risks for rehospitalizations over six years. Regardless of concomitant diagnoses, quantifying cardiac damage with the H₂FPEF score helps in risk-stratifying patients for HF hospitalization and mortality.

Keywords: H2FPEF score; coronary artery disease; heart failure hospitalization; heart failure with preserved ejection fraction.

Grants and funding

Rommel is supported by the Else-Kroener-Fresenius-Foundation. The LIFE-Heart Study was supported by the Roland-Ernst Foundation.