Phenotypes and Clinical Outcome of Heart Failure With Preserved Ejection Fraction Patients in China: Findings From the Chinese Cardiovascular Association Database-Heart Failure Center Registry

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a highly heterogeneous syndrome that poses challenges for therapeutic development and contributes to suboptimal patient outcomes. The phenotypic classification of patients with HFpEF to guide etiology-specific therapeutic strategies represents a rational approach to address the current dilemma. However, the clinical outcomes of HFpEF under different etiological classifications remain poorly understood. Here, we assessed the clinical outcomes of HFpEF patients across different etiological phenotypes, based on a novel classification system comprising five categories: vascular-related, cardiomyopathy-related, right heart/pulmonary-related, valvular/rhythm-related, and extracardiac disease-related HFpEF. Data from the Chinese Cardiovascular Association Database-Heart Failure Center Registry (2017–2021) were analyzed, including 51,466 hospitalized HFpEF patients with 1-year follow-up. Significant differences in baseline characteristics and clinical outcomes were observed among phenotypes. Patients with right heart/pulmonary-related, valvular/rhythm-related, and extracardiac disease-related HFpEF showed a higher incidence of adverse outcomes. Specifically, the right heart/pulmonary-related and valvular/rhythm-related phenotypes were associated with increased heart failure rehospitalization, while extracardiac disease-related HFpEF was linked to higher cardiovascular mortality. Prognostic risk factors also varied across phenotypes. In conclusion, 1-year outcomes exhibit significant variations across HFpEF phenotypic subgroups. Future studies should explore whether phenotype-specific personalized treatment strategies can improve clinical outcomes, especially in high-risk phenotypes.