Heart failure with preserved, mid-range, and reduced ejection fraction across health care settings: an observational study

A.R. de Boer*, I. Vaartjes, A. Gohar, M.J.M. Valk, J.J. Brugts, L.J.M. Boonman-de Winter, E.E. van Riet, Y. van Mourik, H.P. Brunner-La Rocca, G.C.M. Linssen, A.W. Hoes, M.L. Bots, H.M. den Ruijter, F.H. Rutten

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims This study aimed to assess the sex-specific distribution of heart failure (HF) with preserved, mid-range, and reduced ejection fraction across three health care settings.Methods and results In this descriptive observational study, we retrieved the distribution of HF types [with reduced ejection fraction (HFrEF), mid-range ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF)] for men and women between 65 and 79 years of age in three health care settings from a single country: (i) patients with screening-detected HF in the high-risk community (i.e. those with shortness of breath, frailty, diabetes mellitus, and chronic obstructive pulmonary disease) from four screening studies, (ii) patients with confirmed HF from primary care derived from a single observational study, and (iii) patients with confirmed HF from outpatient cardiology clinics participating in a registry. Among 1407 patients from the high-risk community, 288 had screen-detected HF (15% HFrEF, 12% HFmrEF, 74% HFpEF), and 51% of the screen-detected HF patients were women. In both women (82%) and men (65%), HFpEF was the most prevalent HF type. In the routine general practice population (30 practices, 70 000 individuals), among the 160 confirmed HF cases, 35% had HFrEF, 23% HFmrEF, and 43% HFpEF, and in total, 43% were women. In women, HFpEF was the most prevalent HF type (52%), while in men, this was HFrEF (41%). In outpatient cardiology clinics (n = 34), of the 4742 HF patients (66% HFrEF, 15% HFmrEF, 20% HFpEF), 36% were women. In both women (56%) and men (71%), HFrEF was the most prevalent HF type.Conclusions Both HF types and sex distribution vary considerably in HF patients of 65-79 years of age among health care settings. From the high-risk community through to general practice to the cardiology outpatient setting, there is a shift in HF type from HFpEF to HFrEF and a decrease in the proportion of HF patients that are women.
Original languageEnglish
Pages (from-to)363-372
Number of pages10
JournalEsc heart failure
Issue number1
Early online date9 Dec 2021
Publication statusPublished - Feb 2022


  • Heart failure
  • Sex differences
  • HFrEF
  • HFmrEF
  • Screening

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