To determine the impact of internationally recognised criteria for the diagnosis of heart failure with preserved ejection fraction (HF-PEF) on the identification of patients suitable for a clinical study of a novel therapeutic intervention.Methods
We reviewed the notes of 5883 patients admitted with heart failure across 8 hospitals in the UK. The criteria for diagnosis for HF-PEF included (Figure 1): ejection fraction (EF) >50%, structural remodelling, evidence of impaired diastolic function and the absence of significant other cause of symptoms, as recommended in the most recent ESC guidelines.Results
Overall, 20.5% of patients had an EF >50% (Figure 2). There was significant heterogeneity between the hospitals as this proportion varied from 42.4% in the teaching hospitals to 13.8% in the district general hospitals (p < 0.0001). Removing individuals who had other diagnoses that could account for their symptoms reduced the cohort size from 1203 to 122 patients. Of the latter 122, only 45 people had evidence of structural cardiac remodelling and some evidence of raised cardiac filling pressures on echocardiography, consistent with HF-PEF.Conclusion
There may be a degree of under-diagnosis of HF-PEF in less specialised hospitals in the UK. Applying the current ESC criteria for HF-PEF for trial recruitment would limit enrolment to 3.7% of those who have an EF >50% and only 0.8% of all heart failure admissions. These data have important implications for the feasibility of clinical trials for HF-PEF, and for the generalisability of the results of such studies.