Survival of patients with HFpEF in primary care (SurviveHFpEF): cohort study

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

P1.2B.1

Presenter:

Clare Taylor

Twitter:

@clarejtaylor

Co-authors:

Clare J Taylor, Jose Ordonez-Mena, Andrea K Roalfe, Nicholas R Jones, FD Richard Hobbs

Author institutions:

Nuffield Department of Primary Care Health Sciences, University of Oxford

Problem

Heart failure (HF) affects around one million people in the United Kingdom. Classification by ejection fraction at the time of diagnosis - HF with reduced ejection fraction (HFrEF) vs HF with preserved ejection fraction (HFpEF) - is vital to determine treatment options. HFpEF accounts for 25- 50% of all HF but outcome in a community setting is poorly understood. We aimed to report short- and long-term survival in a cohort of patients with HFpEF in primary care.

Approach

SurviveHF is a large population-based cohort study using data from the Clinical Practice Research Datalink (CPRD) between 1st January 2000 and 31st December 2017. The cohort includes 55,959 patients with HF. Patients in SurviveHF with evidence of HFpEF in their GP record were included in the SurviveHFpEF sub-study. Survival rates at one, five and ten years after HFpEF diagnosis were calculated. Kaplan-Meier curves were used to compare survival in people with HFpEF and the HF group overall. Causes of death for the HFpEF cohort were also reported.

Findings

The type of HF was recorded in 3,242 (5.8%) patient records in the SurviveHF cohort overall; 2,032 (3.6%) patients had evidence of HFpEF. Overall, one-, five- and ten-year survival was 90.6% (95%CI 89.3 to 91.9), 60.8% (58.2 to 63.5) and 36.1% (32.6 to 40.0), respectively in the HFpEF group. This compares to 75.9% (75.5 to 76.3) at one year, 45.5% (45.1 to 46.0) at five years, and 24.5% (23.9 to 25.0) at ten years in the HF group overall. Median survival was 7.16 years for those with HFpEF compared to 4.23 years for the total HF group. There were 741 deaths in the HFpEF group across the study period with HF listed on the death certificate in 292 (39.4%) of these patients.

Consequences

A small proportion of patients with HF in primary care have a diagnosis of HFpEF evident in their GP record. Survival in the HFpEF subgroup was better than the HF group overall but remained poor. More accurate recording of HFpEF in primary care could help to identify patients more easily. Further research is needed on interventions which could improve the long-term outlook of all patients with HF, including those with HFpEF.

Submitted by:

Clare Taylor

Funding acknowledgement:

This research is funded by the National Institute for Health Research (NIHR), including NIHR Applied Research Collaboration, Oxford and NIHR Biomedical Research Centre, Oxford, and the Wellcome Trust.