• LamCarolyn S PCSPCardiovascular Research Institute, National University Health System, 1E Kent Ridge Road, Singapore 119228.National Heart Centre Singapore and Duke-National University of Singapore, 5 Hospital Drive, Singapore 169609., Greg D Gamble, Lieng H Ling, David Sim, Kui Toh Gerard Leong, Poh Shuan Daniel Yeo, Hean Yee Ong, Fazlur Jaufeerally, Tze P Ng, Vicky A Cameron, Katrina Poppe, Mayanna Lund, Gerry Devlin, Richard Troughton, RichardsA MarkAMCardiovascular Research Institute, National University Health System, 1E Kent Ridge Road, Singapore 119228.Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road Singapore, Singapore 119228.Christchurch Heart, and Robert N Doughty.
• Cardiovascular Research Institute, National University Health System, 1E Kent Ridge Road, Singapore 119228.
• Eur. Heart J. 2018 May 21; 39 (20): 1770-1780.

AimsWhether prevalence and mortality of patients with heart failure with preserved or mid-range (40-49%) ejection fraction (HFpEF and HFmREF) are similar to those of heart failure with reduced ejection fraction (HFrEF), as reported in some epidemiologic studies, remains highly controversial. We determined and compared characteristics and outcomes for patients with HFpEF, HFmREF, and HFrEF in a prospective, international, multi-ethnic population.Methods And ResultsProspective multi-centre longitudinal study in New Zealand (NZ) and Singapore. Patients with HF were assessed at baseline and followed over 2 years. The primary outcome was death from any cause. Secondary outcome was death and HF hospitalization. Cox proportional hazards models were used to compare outcomes for patients with HFpEF, HFmrEF, and HFrEF. Of 2039 patients enrolled, 28% had HFpEF, 13% HFmrEF, and 59% HFrEF. Compared with HFrEF, patients with HFpEF were older (62 vs. 72 years), more commonly female (17% vs. 48%), and more likely to have a history of hypertension (61% vs. 78%) but less likely to have coronary artery disease (55% vs. 41%). During 2 years of follow-up, 343 (17%) patients died. Adjusting for age, sex, and clinical risk factors, patients with HFpEF had a lower risk of death compared with those with HFrEF (hazard ratio 0.62, 95% confidence interval 0.46-0.85). Plasma (NT-proBNP) was similarly related to mortality in both HFpEF, HFmrEF, and HFrEF independent of the co-variates listed and of ejection fraction. Results were similar for the composite endpoint of death or HF and were consistent between Singapore and NZ.ConclusionThese prospective multinational data showed that the prevalence of HFpEF within the HF population was lower than HFrEF. Death rate was comparable in HFpEF and HFmrEF and lower than in HFrEF. Plasma levels of NT-proBNP were independently and similarly predictive of death in the three HF phenotypes.Trial RegistrationAustralian New Zealand Clinical Trial Registry (ACTRN12610000374066).

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