Identification of distinct phenotypic clusters in heart failure with preserved ejection fraction

A. Uijl*, G. Savarese, I. Vaartjes, U. Dahlstrom, J.J. Brugts, G.C.M. Linssen, V. van Empel, H.P. Brunner-La Rocca, F.W. Asselbergs, L.H. Lund, A.W. Hoes, S. Koudstaal

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims We aimed to derive and validate clinically useful clusters of patients with heart failure with preserved ejection fraction (HFpEF; left ventricular ejection fraction >= 50%).Methods and results We derived a cluster model from 6909 HFpEF patients from the Swedish Heart Failure Registry (SwedeHF) and externally validated this in 2153 patients from the Chronic Heart Failure ESC-guideline based Cardiology practice Quality project (CHECK-HF) registry. In SwedeHF, the median age was 80 [interquartile range 72-86] years, 52% of patients were female and most frequent comorbidities were hypertension (82%), atrial fibrillation (68%), and ischaemic heart disease (48%). Latent class analysis identified five distinct clusters: cluster 1 (10% of patients) were young patients with a low comorbidity burden and the highest proportion of implantable devices; cluster 2 (30%) patients had atrial fibrillation, hypertension without diabetes; cluster 3 (25%) patients were the oldest with many cardiovascular comorbidities and hypertension; cluster 4 (15%) patients had obesity, diabetes and hypertension; and cluster 5 (20%) patients were older with ischaemic heart disease, hypertension and renal failure and were most frequently prescribed diuretics. The clusters were reproduced in the CHECK-HF cohort. Patients in cluster 1 had the best prognosis, while patients in clusters 3 and 5 had the worst age- and sex-adjusted prognosis.Conclusions Five distinct clusters of HFpEF patients were identified that differed in clinical characteristics, heart failure drug therapy and prognosis. These results confirm the heterogeneity of HFpEF and form a basis for tailoring trial design to individualized drug therapy in HFpEF patients.
Original languageEnglish
Pages (from-to)973-982
Number of pages10
JournalEuropean journal of heart failure
Issue number6
Publication statusPublished - 1 Jun 2021


  • Heart failure with preserved ejection fraction
  • Comorbidities
  • Treatment
  • Latent class analysis
  • Clusters
  • Phenotyping
  • External validation

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