Complications
HFpEF is one of the leading causes of pulmonary hypertension, and pulmonary hypertension in the setting of HFpEF (PH-HFpEF) is reported to be increasing in prevalence.[148][149] Patients with HFpEF who develop pulmonary hypertension have more severe symptoms and more adverse outcomes (exercise intolerance, frequent hospitalisations, right heart failure, and reduced survival) than those without pulmonary hypertension.[148] Management of PH-HFpEF is challenging because of the lack of effective therapies.
In a series of 1941 patients at a single centre from 1995 to 2004, the incidence of sudden death was 2.1%. Five variables were found to be independently associated with a significant increased risk of sudden cardiac death: diabetes mellitus, presence of mitral regurgitation, severity of chronic heart failure, occurrence of an myocardial infarction within 3 days prior to index cardiac catheterisation, and severity of coronary artery disease.[147]
Acute pulmonary oedema is the presenting symptom in approximately 20% of patients with HFpEF.[14]
Patients with heart failure have several factors that may put them at a high risk of hyperkalaemia; these include factors that are directly related to the condition (i.e., impaired delivery of sodium and water to the distal renal tubule), associated comorbidities (e.g., diabetes, chronic kidney disease), and use of drugs that cause hyperkalaemia.[3][150]
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