CORRESPONDENCE: LETTER TO THE EDITOR
Impact of Diastolic Dysfunction on Heart Failure-Related Hospitalizations
Vincent L. Sorrell, MD, FACC, FASE,
Nishant Kalra, MD* and
Radhakrishnan Ramaraj, MD
* Sarver Heart Center, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Room 4143, Tucson, Arizona 85712 (Email: nkalra_dr{at}yahoo.com).
Fang et al. (1), using National Hospital Discharge Survey data, showed a steady increase in heart failure hospitalizations from 1979 to 2004. More than 80% were elderly (age >65 years). The median hospital stay and proportion of in-hospital deaths declined during this period. This declining mortality was related to improvement in medical therapy and widespread availability of revascularization procedures.
Over the last 3 decades, a novel syndrome, heart failure with preserved systolic function (diastolic dysfunction), has been increasingly recognized. This predominantly involves the elderly and is responsible for approximately 50% of heart failures in this group (2,3). Fang et al. (1) did not mention left ventricular function in their report, and the impact of diastolic heart failure in their conclusions is speculation.
Recent epidemiologic data have confirmed the increasing prevalence and hospitalization of patients with diastolic dysfunction (3). Over the last 2 decades, there have been significant advances in the management of heart failure, but these have almost exclusively focused on a population with systolic dysfunction. Survival among patients with preserved ejection fraction has been shown to be better than that among those with reduced ejection fractions (4,5).
In their report, the investigators highlighted an increase in the hospitalization of women with heart failure, relative to men. Given the generally older female U.S. population, patients with diastolic dysfunction have consistently been shown to more likely be female (5,6).
Therefore, the increase in the prevalence of diastolic heart failure likely has a major contribution to the findings of Fang et al. (1) and may entirely account for the increase in hospitalization, the aged population, the gender discrepancy, as well as the demonstrated improved survival.
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1. Fang J, Mensah GA, Croft JB, Keenan NL. Heart failure-related hospitalization in the U.S., 1979 to 2004 J Am Coll Cardiol 2008;52:428-434.[Abstract/Free Full Text]2. Owan TE, Redfield MM. Epidemiology of diastolic heart failure Prog Cardiovasc Dis 2005;47:320-332.[CrossRef][Web of Science][Medline] 3. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction N Engl J Med 2006;355:251-259.[CrossRef][Medline] 4. Smith GL, Masoudi FA, Vaccarino V, Radford MJ, Krumholz HM. Outcomes in heart failure patients with preserved ejection fraction: mortality, readmission, and functional decline J Am Coll Cardiol 2003;41:1510-1518.[Abstract/Free Full Text] 5. Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort J Am Coll Cardiol 1999;33:1948-1955.[Abstract/Free Full Text] 6. Bhatia RS, Tu JV, Lee DS, et al. Outcome of heart failure with preserved ejection fraction in a population-based study N Engl J Med 2006;355:260-269.[CrossRef][Medline]
Related Article
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Reply
- Jing Fang, Nora L. Keenan, George A. Mensah, and Janet B. Croft
J. Am. Coll. Cardiol. 2009 53: 457-458.
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