Clinical Phenotypes and Age-Related Differences in Presentation, Treatment, and Outcome of Heart Failure with Preserved Ejection Fraction: A Vietnamese Multicenter Research

摘要

Background . Heart failure with preserved ejection fraction (HFpEF) is a rising health problem with heterogeneous presentation and no evidence-based treatment. While Southeast Asia reported the highest mortality and morbidity among Asian population, little is known about the Vietnamese population, including patient characteristics, prescribing pattern and mortality rate. Methods . We conducted an observational study on 477 patients diagnosed with HFpEF from seven hospitals in Southern Vietnam from January 2019 to December 2019. Results . Mean age was 67.6 (40.9%??65 years). 62.3% were female. 82.4% were diagnosed within 5 years. Dyspnea, congestion, and hypoperfusion on admission were noted in 63.9%, 48.8%, and 4.6% of the patients, respectively. Median ejection fraction was 63%. Valvular heart disease (VHD) was the leading cause of heart failure (35.9%). 78.6% had at least two comorbidities, mostly hypertension (68.6%). 30.6% of the patients were hospitalized, with a median stay of 7.0 (4.0–10.0) days and inhospital mortality of 4.8%. Older patients (≥65 years) were more likely to be females (OR?=?1.52); had multimorbid conditions (OR?=?3.14), including hypertension (OR?=?4.28), diabetes (OR?=?1.73), coronary artery disease (CAD) (OR?=?2.50), dyslipidemia (OR?=?1.94), and chronic kidney disease (OR?=?2.44); and were more frequently prescribed statin (OR?=?3.15). Younger individuals (65 years) were associated with higher mineralocorticoid antagonist uptake (OR?=?0.52) and VHD (OR?=?0,40). Prescription rate for renin-angiotensin-aldosterone system inhibitor, beta blocker, mineralocorticoid antagonist, and loop diuretic was 72.5%, 59.1%, 43.0%, and 60.6%, respectively. Four phenotypes were identified, including the lean/elderly/multimorbid; congestive/metabolic; CAD-induced; and younger/atrial fibrillation (AF)/VHD. The novel phenotype “younger/AF/VHD” exhibited high symptom burden and poor functional capacity despite being the youngest and least multimorbid. The “lean/elderly/multimorbid” phenotype demonstrated the highest symptom severity and inhospital mortality. Conclusions . Our research highlights a younger, predominantly female population with high disease burden. The four novelly identified phenotypes provide contemporary and pragmatic insights into a phenotype-guided approach, exclusively targeting the Vietnamese population.