“Patients with HFpEF are known to have an increasing comorbidity burden, which can result in a heightened risk for mortality if poorly managed,” Zainali S. Chunawala, MBBS, explains. “Although a greater prevalence of comorbidities has routinely been reported for women with HFpEF relative to men, less is known about the gender-specific comorbidity burden of patients hospitalized with acute versus chronic HFpEF. Moreover, data on the characteristics and post-discharge outcomes of patients with HFpEF who are admitted for non-HF reasons is limited.”
For a paper published in The American Journal of Cardiology, Chunawala and colleagues sought to examine the gender-specific comorbidity burden and mortality outcomes among patients with HFpEF hospitalized for either acute decompensated HF (ADHF) or a non-HF cause. They examined community surveillance from the Atherosclerosis Risk in Communities (ARIC) Study.
In the ARIC study, the researchers performed adjudicated community surveillance of HF hospitalizations between 2005 and 2014 in four regions throughout the United States. HFpEF was defined by an ejection fraction of greater than or equal to 50%. Hospitalized cases of ADHF and chronic stable HF (CSHF) were sampled using prespecified discharge codes and categorized according to signs or symptoms of acute or worsening HF upon physician review of the medical record.
Higher Comorbidity Burden in Women
Investigators sampled 13,706 weighted and 2,936 unweighted hospitalizations among patients with HFpEF (mean age, 77; 64% women; 29% Black) and adjudicated ADHF (86%) or CSHF (14%). The rate of comorbidities was high in both ADHF and CSHF hospitalizations, regardless of gender.
“Women hospitalized with ADHF versus CSHF had a greater prevalence of hypertension, diabetes, and renal disease,” Chunawala says. “However, for both genders, echocardiographic features such as left ventricular hypertrophy and valvular abnormalities were more common with ADHF. Interestingly, the all-cause mortality was comparable for the two groups, suggesting that patients with HFpEF who are hospitalized with ADHF versus other causes experience an equally high risk for death.”
The observation that women with ADHF had a significantly higher rate of cardiometabolic comorbidities such as hypertension, diabetes mellitus, and renal disease compared with women with CSHF is a key finding, according to Chunawala (Figure).
“However, ADHF was tied to a lower prevalence of coronary heart disease, sleep apnea, and depression in men,” he notes. “These findings indicate the need to optimize therapeutic approaches and comorbidity management for HFpEF in women hospitalized with ADHF.”
ECG abnormalities were more common in patients with ADHF compared with CSHF, regardless of gender. “We saw a higher rate of left ventricular hypertrophy, pulmonary hypertension, and valvular defects, such as mitral regurgitation and aortic regurgitation, in patients with ADHF compared with CSHF, which could be tied to volume overload, age, and cardiac remodeling,” Chunawala says. “These observations emphasize the need for early intervention referral, which could help reduce the onset of ADHF and improve the prognosis in this vulnerable population.”
Effective Comorbidity Management Is Key
The findings also underscore the importance of effective comorbidity management for both patients with ADHF and patients admitted for non-HF causes, “a high-risk group that is underappreciated in clinical practice guidelines,” according to Chunawala. “Advanced therapeutic approaches and effective strategies aimed at improving specific cardiometabolic conditions in patients with HFpEF might help reduce the rehospitalization rates and improve outcomes in this cohort,” he says.
Future research should aim to understand the gender-specific pathophysiology of HFpEF, particularly in women, Chunawala notes. “There is a need to deepen our understanding of the characteristics and post-discharge outcomes of patients with HFpEF hospitalized with CSHF—ie, hospitalization for non-HF causes.”