Changes in the prevalence of heart failure phenotypes over time and their association with patient prognosis

The prevalence and phenotypic frequency of heart failure (HF) vary across populations; yet, little is known about how the rates of individual HF phenotypes shift over time and how such changes affect patient outcomes.

We aimed to evaluate temporal trends in HF phenotype prevalence and their associations with patient characteristics and prognosis.

We retrospectively analyzed data from 2597 patients hospitalized with HF between January 2014 and May 2019. The patients were categorized into tertiles according to time of their admission to a hospital, and stratified by HF phenotype into HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). We assessed changes in phenotype prevalence, patient clinical characteristics, and survival. Data were obtained from hospital records and the National Health Fund. The end point was all‑cause death or censoring on May 25, 2023.

Between the first and third tertiles, the prevalence of HFrEF decreased by 27% and the prevalence of HFmrEF and HFpEF increased by 53% and 92%, respectively. There was a progressive increase in the proportion of older patients, women, and the number of comorbidities, particularly hypertension, atrial fibrillation, diabetes, and cancer. The 5‑year survival rates improved across tertiles for all HF patients (from 48.4% to 60.2%; P <0.001), with the greatest gains observed in the HFrEF group (from 45.7% to 57%; P <0.001). After adjusting for confounders, hospitalization during the second and third tertiles remained an Conclusions: During the study period, the proportion of patients with HFpEF and HFmrEF increased, and this shift was paralleled by a growing proportion of elderly and female patients and a rising burden of comorbidities. However, overall survival improved, particularly among the HFrEF patients.