1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Diastolic Heart Failure in the Community: Prevalence and Impact

Heart failure with preserved ejection fraction and diastolic dysfunction appears to be common.

Heart failure with preserved ejection fraction (EF) and diastolic dysfunction is increasingly thought to be important, but past studies have focused on hospital-based populations. In a population-based study, Mayo Clinic researchers assessed the characteristics of 556 Olmsted County, Minnesota, residents with heart failure (all of whom underwent echocardiography within a few days of diagnosis, and 501 of whom had brain natriuretic peptide [BNP] levels measured). The mean age was 76 years, and comorbidity was substantial irrespective of EF.

Of the 556 subjects, 55% had preserved EF (defined as 50%) and 45% had reduced EF. Those with preserved EF were more likely than those with reduced EF to be older and female, and less likely to have a history of myocardial infarction (36% vs. 50%). Diastolic dysfunction was moderate or severe in 78% of subjects with reduced EF and in 71% of those with preserved EF. BNP levels were higher in subjects with reduced EF than in those with preserved EF (mean, 388 vs. 183 pg/dL); high BNP levels also were associated with diastolic dysfunction. Six-month mortality rates were 16% both for subjects with preserved EF and for those with reduced EF.

Comment: This study, purported to be the first large community-based study of heart failure, confirms that heart failure with preserved EF is common and is associated with mortality equal to that of heart failure with reduced EF. Diastolic dysfunction is common irrespective of EF; as an editorialist notes, the pathophysiologic mechanisms of diastolic dysfunction, and effective treatments for it, deserve more intense study.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine November 7, 2006

Citation(s):

Bursi F et al. Systolic and diastolic heart failure in the community. JAMA 2006 Nov 8; 296:2209-16.

• Original article (Subscription may be required)
• Medline abstract (Free)

Hildebrandt P. Systolic and nonsystolic heart failure: Equally serious threats. JAMA 2006 Nov 8; 296:2259-60.

• Original article (Subscription may be required)
• Medline abstract (Free)