
Abstract Aims While heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF) are well described, determinants and outcomes of heart failure with mid-range ejection fraction (HFmrEF) remain unclear. We sought to examine clinical and biochemical predictors of incident HFmrEF in the community. Methods and results We pooled data from four community-based longitudinal cohorts, with ascertainment of new heart failure (HF) classified into HFmrEF [ejection fraction (EF) 41–49%], HFpEF (EF ≥50%), and HFrEF (EF ≤40%). Predictors of incident HF subtypes were assessed using multivariable Cox models. Among 28 820 participants free of HF followed for a median of 12 years, there were 200 new HFmrEF cases, compared with 811 HFpEF and 1048 HFrEF. Clinical predictors of HFmrEF included age, male sex, systolic blood pressure, diabetes mellitus, and prior myocardial infarction (multivariable adjusted P ≤ 0.003 for all). Biomarkers that predicted HFmrEF included natriuretic peptides, cystatin-C, and high-sensitivity troponin (P ≤ 0.0004 for all). Natriuretic peptides were stronger predictors of HFrEF [hazard ratio (HR) 2.00 per 1 standard deviation increase, 95% confidence interval (CI) 1.81–2.20] than of HFmrEF (HR 1.51, 95% CI 1.20–1.90, P = 0.01 for difference), and did not differ in their association with incident HFmrEF and HFpEF (HR 1.56, 95% CI 1.41–1.73, P = 0.68 for difference). All-cause mortality following the onset of HFmrEF was worse than that of HFpEF (50 vs. 39 events per 1000 person-years, P = 0.02), but comparable to that of HFrEF (46 events per 1000 person-years, P = 0.78). Conclusions We found overlap in predictors of incident HFmrEF with other HF subtypes. In contrast, mortality risk after HFmrEF was worse than HFpEF, and similar to HFrEF.
Male, Ejection fraction, Cardiorespiratory Medicine and Haematology, Heart Ventricles/diagnostic imaging, Cardiovascular, Heart Failure/diagnosis, Cause of Death, Prospective Studies, 32 Biomedical and Clinical Sciences (for-2020), Male (mesh), Humans (mesh), Survival Rate/trends, 3 Good Health and Well Being (sdg), Follow-Up Studies (mesh), Incidence, 3201 Cardiovascular medicine and haematology (for-2020), Stroke Volume (mesh), Heart Failure (mesh), Middle Aged, United States/epidemiology, Prognosis, Survival Rate, Heart Disease, Echocardiography, Cardiovascular (rcdc), Risk Assessment (mesh), Female, United States (mesh), Survival Rate (mesh), Heart Ventricles, Clinical Sciences, Heart Disease (rcdc), 610, Cause of Death/trends, Heart failure, Echocardiography (mesh), Cardiovascular medicine and haematology, Risk Assessment, SDG 3 - Good Health and Well-being, Cause of Death (mesh), Incidence (mesh), 1102 Cardiorespiratory Medicine and Haematology (for), Heart Ventricles (mesh), Middle Aged (mesh), Journal Article, Humans, Prospective Studies (mesh), Cardiovascular System & Hematology (science-metrix), 3202 Clinical Sciences (for-2020), Aged, Heart Failure, Cardiovascular (hrcs-hc), Biomedical and Clinical Sciences, Aged (mesh), Stroke Volume, Prognosis (mesh), United States, Good Health and Well Being, Cardiovascular System & Hematology, Stroke Volume/physiology, Female (mesh), Risk factor, Follow-Up Studies
Male, Ejection fraction, Cardiorespiratory Medicine and Haematology, Heart Ventricles/diagnostic imaging, Cardiovascular, Heart Failure/diagnosis, Cause of Death, Prospective Studies, 32 Biomedical and Clinical Sciences (for-2020), Male (mesh), Humans (mesh), Survival Rate/trends, 3 Good Health and Well Being (sdg), Follow-Up Studies (mesh), Incidence, 3201 Cardiovascular medicine and haematology (for-2020), Stroke Volume (mesh), Heart Failure (mesh), Middle Aged, United States/epidemiology, Prognosis, Survival Rate, Heart Disease, Echocardiography, Cardiovascular (rcdc), Risk Assessment (mesh), Female, United States (mesh), Survival Rate (mesh), Heart Ventricles, Clinical Sciences, Heart Disease (rcdc), 610, Cause of Death/trends, Heart failure, Echocardiography (mesh), Cardiovascular medicine and haematology, Risk Assessment, SDG 3 - Good Health and Well-being, Cause of Death (mesh), Incidence (mesh), 1102 Cardiorespiratory Medicine and Haematology (for), Heart Ventricles (mesh), Middle Aged (mesh), Journal Article, Humans, Prospective Studies (mesh), Cardiovascular System & Hematology (science-metrix), 3202 Clinical Sciences (for-2020), Aged, Heart Failure, Cardiovascular (hrcs-hc), Biomedical and Clinical Sciences, Aged (mesh), Stroke Volume, Prognosis (mesh), United States, Good Health and Well Being, Cardiovascular System & Hematology, Stroke Volume/physiology, Female (mesh), Risk factor, Follow-Up Studies
| selected citations These citations are derived from selected sources. This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically). | 115 | |
| popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network. | Top 1% | |
| influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically). | Top 10% | |
| impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network. | Top 10% |
