Changes in the prevalence of heart failure phenotypes over time and their association with patients' prognosis.

Introduction: The prevalence and phenotypic frequency of heart failure (HF) vary across populations, yet little is known about how these phenotypes change over time and how such changes affect patient outcomes.

Objectives: To evaluate temporal trends in HF phenotype prevalence and their associations with patients' characteristics and prognosis.

Patients and methods:  We retrospectively analyzed data from 2597 patients hospitalized with HF between January 2014 and May 2019. Patients were categorized into tertiles according to their time of hospital admission and stratified by HF phenotype: HFrEF, HFmrEF, and HFpEF. We assessed changes in phenotype prevalence, clinical characteristics, and survival. Data were obtained from hospital records and the National Health Fund. The endpoint was all-cause mortality or censoring on May 25, 2023.

Results:   A 27% decrease in the prevalence of HFrEF and an increase in HFmrEF and HFpEF (53% and 92%, respectively) were observed between the first and third tertile. There was a progressive increase in the proportion of older patients, women, and comorbidities, particularly hypertension, atrial fibrillation, diabetes, and cancer. 5-year survival improved across tertiles for all HF patients (48.4% to 60.2%, P <0.001), with significant gains observed in HFrEF (45.7% to 57.0%, P <0.001). After adjusting for confounders, the later tertiles remained independent predictors of better survival compared to the first tertile.

Conclusions:  The proportion of HFpEF and HFmrEF patients has increased recently and this shift was paralleled by a growing proportion of elderly and female patients and a rising burden of comorbidities. However overall survival has improved, particularly among HFrEF patients.