Prevalence, feature and treatment in a cohort of patients hospitalized for heart failure with preserved systolic function: data from the PRESYF-HF Toscana study

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.