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Background: The prevalence and the characteristics of heart failure (HF) with preserved systolic function (more commonly named diastolic heart failure) may differ according to the type of the study (population based or cohort), setting, methods to define the cardiac function, so epidemiologic data are actually quite variable ranging from 15% to over 60% of HF patients. Moreover the treatment is still based more on physiopathologic data of the single case for no evidence based therapy has been defined. Materials and methods: We have studied a cohort of 338 consecutive patients admitted for HF at 24 Internal Medicine Units; all patients had a left ventricular ejection fraction (LVEF) echographically measured within 72 hours from hospital admission. Patients with LVEF > 50% were considered to have preserved systolic function (PRESYF). The prevalence and the clinical characteristics of the patients were recorded as well the therapy at the admission and at the discharge. Pharmacologic treatment was analyzed for each category of drug normalized for equivalent dosage at the admission and at the discharge. Results: The patients with LVEF > 50% were 112 (33.1%); they were older than the subjects with depressed systolic function but the difference in our cohort was not statistically significant; the clinical presentation is similar but female sex, hypertensive ethiology, and elevated BMI prevail. ACE-inhibitors and diuretics are the most frequent drugs prescribed in both forms of HF, with no difference in prescription and dosage at the admission and at the discharge. Beta-blockers were prescribed at a higher dosage in the subjects with depressed than with preserved systolic function (17.86 + 15.90 mg/die vs 9.69 + 9.06 mg/die; p < 0.05). Discussion: One third of patients admitted in hospital for HF has DHF; these patients differ from HF with depressed systolic function for female sex, hypertensive ethiology, and elevated BMI. Taking into account the advanced age of both groups (mean age 81 year) the treatment is aimed above all to control symptoms (actually diuretics are the most used drugs). No difference was registered in prescription and dosage of HF therapy in both forms, with the exception of a wider and a higher dosage of beta-blockers in depressed systolic function. Conclusions: Diastolic HF is a diffuse problem in the real world and account for one third of inhospital admission. Patients are old, complex and present comorbidities. The treatment is still tailored more on single patient physiopathologic data than on evidence base. The prescription ‘‘habits’’ we have registered at the discharge from hospital are the snapshot of what the patients assume in the real world.

Background. There is uncertainty about the prevalence and clinical characteristics of heart failure (HF) patients with preserved systolic function (PRESYF). Aim. To analyze the prevalence and clinical characteristics of patients with PRESYF in an unselected cohort of subjects consecutively hospitalized for HF. Methods. The study cohort included 338 patients consecutively admitted for HF at 24 Internal Medicine units homogeneously settled in Tuscany area (Italy). We did not have any criteria for exclusion. All patients had an echocardiographic measure of left ventricular ejection fraction (LVEF) within 72 hours from hospital admission. Patients with LVEF > 50% were considered to have PRESYF. Results. The patients with PRESYF were 112 (33,1%), those with depressed systolic function (DESYF) 226 (66,9%). In the group PRESYF were prevalent female sex, hypertensive etiology, and elevated BMI. The distribution for classes of age shows a great frequency of PRESYF in the elderly. Conclusion. About one third of patients admitted for HF have a PRESYF. They are different compared to those with DESYF. A correct identification of this form of HF may be important in clinical practice for more targeted therapeutic options and for prognostic implications.