Heart failure with preserved ejection fraction: is this diastolic heart failure?

As described in the study by Smith et al. (1) published in this issue of the Journal, the syndrome of “heart failure with a preserved ejection fraction” includes patients admitted to the hospital with symptoms and signs of heart failure (HF), radiographic evidence of HF, and an ejection fraction (EF) 40%. Approximately one-half of the consecutively enrolled patients with HF had an EF 40%, indicating a prevalence of 50%. Mortality, hospital readmission, and functional status in this group of patients were compared to patients with HF and a depressed EF. This comparison revealed that these two groups of patients with HF have unique, statistically significant, and clinically important differences. Patients with HF and a preserved EF tended to be older, were more often women, more frequently had hypertension, and less frequently had coronary artery disease. The mortality rate in these patients was significantly less than in patients with HF and a depressed EF, but was significantly greater than age-matched control patients without HF. Therefore, these important differences in demographics and mortality justify the classification of patients with HF into two groups.