Prognosis

Risk factor modification is the key in preventing or delaying the onset of overt clinical heart failure. Once heart failure has been diagnosed, the prognosis of patients with HFpEF appears to be similar to that of patients with impaired systolic function. The reported rates of mortality (1 year and 5 years), readmission for heart failure, and in-hospital complications are similar between the 2 groups.[12][14]

Higher levels of NT-pro-BNP are associated with increased risk of all cause mortality and heart failure hospitalizations.[146]

Presence of anemia might be an indicator for poor prognosis and/or increased mortality and should be treated appropriately.[147]

Depression is found in 20% to 40% of heart failure patients and is associated with increased morbidity and mortality, when compared with heart failure patients without depression.[148][149][150]​ Therefore, there is a need for screening and early intervention when depression is present.[151]

One study looking at comorbidities in two large cohorts of patients (one from 2002 and one from 2017) found that in the earlier cohort, cerebrovascular disease, diabetes mellitus, and chronic kidney disease (CKD) were independent predictors for adverse outcome (HF hospitalization and all-cause mortality during a total follow-up of 1.5 years), and atrial fibrillation/flutter showed a nonsignificant trend towards poor outcome. In the later 2017 cohort, the independent predictors were anemia, obesity and COPD, with CKD showing a trend towards poor outcome. Other chronic conditions included in the model were not independently associated with prognosis, however an overall higher comorbidity burden was associated with an increased risk of HF hospitalization or all-cause mortality.[18]

A meta-analysis suggests that even a pseudonormal diastolic filling pattern is associated with an increased risk of death compared with abnormal relaxation or a normal pattern, and the risk is similar to that noted with a restrictive filling pattern.[152]

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