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Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective
R S Vasan1, E J Benjamin, D Levy
1Framingham Heart Study, Massachusetts 01701, USA.
Insights
Diastolic heart failure, affecting about one-third of congestive heart failure patients, presents similar symptoms to systolic heart failure. Optimal treatment requires further research due to varied study findings.
Area of Science:
- Cardiology
- Heart Failure Research
- Clinical Medicine
Background:
- Approximately one-third of congestive heart failure (CHF) patients exhibit normal left ventricular systolic function.
- These patients are presumed to have heart failure stemming from ventricular diastolic dysfunction.
- Diastolic heart failure (DHF) presents a significant, yet often overlooked, clinical challenge.
Purpose of the Study:
- To provide a comprehensive overview of published reports on the prevalence, clinical features, and prognosis of DHF.
- To identify and recommend directions for future research in DHF.
- To synthesize existing knowledge on DHF for better clinical understanding.
Main Methods:
- Systematic review of 31 studies published between January 1970 and March 1995.
- Studies focused on patients with CHF and normal left ventricular systolic function.
- Data was identified through computer-based searches of relevant databases.
Main Results:
- Reported prevalence of normal ventricular systolic performance in CHF patients varied widely (13% to 74%).
- Annual mortality rates for DHF also showed significant variation (1.3% to 17.5%).
- Prevalence and prognosis are influenced by criteria for CHF, chronicity, and patient age.
Conclusions:
- Heterogeneity in previous studies complicates comparisons and understanding of DHF.
- Prospective, community-based studies are needed to define DHF's incidence, prevalence, and natural history.
- Randomized clinical trials are essential to establish optimal treatment strategies for DHF.
Abstract:
Numerous reports suggest that about one-third of patients with congestive heart failure do not have any abnormality of left ventricular systolic function. These patients presumably have heart failure on the basis of ventricular diastolic dysfunction. Our objective was to develop a comprehensive overview of published reports of the prevalence, clinical features and prognosis of diastolic heart failure and to offer recommendations for future studies. Thirty-one studies of patients with congestive heart failure with normal left ventricular systolic function were published in the time period from January 1970 through March 1995. These studies were identified with the use of computer-based searches in relevant data bases. Among patients with congestive heart failure, the prevalence of normal ventricular systolic performance in the published reports varies widely from 13% to 74%; the reported annual mortality rate also varies from 1.3% to 17.5%. The criteria for congestive heart failure, its chronicity and the age of the study sample affect the reported prevalence and prognosis of the disorder. The clinical signs and symptoms of diastolic heart failure are similar to those of patients with systolic heart failure, underscoring the need for evaluation of ventricular systolic function in patients with congestive heart failure. In the absence of any large-scale randomized clinical trial targeting these patients, the optimal treatment of diastolic heart failure is unclear. We conclude that the heterogeneity in previous studies of diastolic heart failure hinders the comparison of published reports. There is a need to conduct prospective, community-based investigations to better characterize the incidence, prevalence and natural history of diastolic heart failure. Randomized clinical trials are needed to determine optimal treatment strategies.