Prospective registry of heart failure with preserved ejection fraction in México: EDIFICE-Mx

Abstract

Background and aims

Heart failure with preserved ejection fraction (HFpEF) is an increasingly common clinical syndrome, estimated to constitute approximately 50 % of all heart failure (HF) cases. Nonetheless, registries from specific geographic areas, as Latin America, are lacking. The present study aims to report the underlying causes, comorbidities, treatment patterns and outcomes of patients with HFpEF in a large cardiovascular center in Mexico City.

Methods

The present is a prospective, longitudinal, observational study, including female and male patients over 18 years of age, who presented to the emergency department, coronary care unit or outpatient department of the National Institute of Cardiology Ignacio Chavez in Mexico City with HFpEF. Patients were classified according to different phenotypes and current literature. The primary outcome was the composite total HFpEF hospitalization and all-cause mortality.

Results

Within a median follow-up of 472 (IQR 425–518) days, total mortality was 14.56 %, with 10.68 % attributed to cardiovascular causes. HF hospitalization was 7.77 %. Atrial fibrillation showed a notable association with outcomes (adjusted HR 2.87, P = 0.028). Beta-blocker showed a non-significant trend towards benefit, while mineralocorticoid receptor antagonists (MRA) significantly influenced outcomes (adjusted HR 3.30, P = 0.018). The primary composite endpoint occurred in 19.42 % of patients, with no significant difference among phenotypes (P = 0.536).

Conclusions

We observed a substantial comorbidity burden impacting quality of life, as indicated by KCCQ scores. There was a high incidence of hard endpoints, including cardiovascular death and hospitalizations, alongside significant variability in treatment utilization. Future research should focus on elucidating individual healthcare trajectories in HFpEF patients and promoting wider adoption of evidence-based therapies.