期刊
JACC-CARDIOVASCULAR IMAGING
卷 11, 期 1, 页码 1-11出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcmg.2017.08.007
关键词
echocardiography; ejection fraction; epidemiology; heart failure
资金
- National Heart, Lung, and Blood Institute [NO1-HC-25195, HHSN268201500001I]
- National Institutes of Health/National Heart, Lung, and Blood Institute [K23HL118529, R01-HL131532, R01-HL134168, R01HL080124]
- Harvard Medical School Fellowship
- National Institute of Health [1R01HL128914, 2R01 HL092577]
- Evans Scholar award
- Jay and Louise Coffman endowment, Department of Medicine, Boston University School of Medicine
- DIVISION OF EPIDEMIOLOGY AND CLINICAL APPLICATIONS [N01HC025195] Funding Source: NIH RePORTER
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [R01HL131532, R01HL092577, R01HL128914, R01HL080124, K23HL118529, R01HL134168] Funding Source: NIH RePORTER
OBJECTIVES The purpose of this study was to describe the temporal trends in prevalence of left ventricular systolic dysfunction (LVSD) in individuals without and with heart failure (HF) in the community over a 3-decade period of observation. BACKGROUND Temporal trends in the prevalence and management of major risk factors may affect the epidemiology of HF. METHODS We compared the frequency, correlates, and prognosis of LVSD (left ventricular ejection fraction [LVEF] <50%) among Framingham Study participants without and with clinical HF in 3 decades (1985 to 1994, 1995 to 2004, and 2005 to 2014). RESULTS Among participants without HF (12,857 person-observations, mean age 53 years, 56% women), the prevalence of LVSD on echocardiography decreased (3.38% in 1985 to 1994 vs. 2.2% in 2005 to 2014; p < 0.0001), whereas mean LVEF increased (65% vs. 68%; p < 0.001). The elevated risk associated with LVSD (similar to 2- to 4-fold risk of HF or death) remained unchanged over time. Among participants with new-onset HF (n = 894, mean age 75 years, 52% women), the frequency of heart failure with preserved ejection fraction (HFpEF) increased (preserved LVEF >= 50%: 41.0% in 1985 to 1994 vs. 56.17% in 2005 to 2014; p < 0.001) and heart failure with reduced ejection fraction (HFrEF) decreased (reduced LVEF <40%: 44.10% vs. 31.06%; p = 0.002), whereas heart failure with midrange LVEF remained unchanged (LVEF 40% to <50%: 14.90% vs. 12.77%; p = 0.66). Cardiovascular mortality associated with HFrEF declined across decades (hazard ratio: 0.61; 95% confidence interval: 0.39 to 0.97), but remained unchanged for heart failure with midrange LVEF and HFpEF. Approximately 47% of the observed increase in LVEF among those without HF and 75% of the rising proportion of HFpEF across decades was attributable to trends in risk factors, especially a decline in the prevalence of coronary heart disease among those with HF. CONCLUSIONS The profile of HF in the community has changed in recent decades, with a lower prevalence of LVSD and an increased frequency of HFpEF, presumably due to concomitant risk factor trends. (C) 2018 by the American College of Cardiology Foundation.
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