Diastolic heart failure in the community: Clinical profile, natural history, therapy, and impact of proposed diagnostic criteria

Background: Diastolic heart failure (DHF) has been broadly defined as "signs and symptoms of congestive heart failure (CHF) with normal/near normal systolic function." The clinical profile and natural history of the syndrome remain controversial. Furthermore, the frequency with which patients with CHF and normal ejection fraction (EF) fulfill recently proposed standardized diagnostic criteria for DHF is unclear. Our objective was to determine the clinical profile, Doppler echocardiographic features, current management, prognosis, and predictors of outcome of all patients with new onset CHF who had normal EF in Olmsted County, Minnesota, during 1996-1997. The frequency with which patients met recently proposed standardized criteria for diagnosis of DHF was assessed. Methods: Using the resources of the Rochester Epidemiology Project, all residents of Olmsted County, Minnesota, with a new diagnosis of CHF in 1996-1997, an ejection fraction >45%, and no valve disease (n = 83) were identified. Results: Patients were elderly (79 +/- 13 yr), predominately female (76%), and had hypertension and/or coronary artery disease (85%). New-onset atrial fibrillation, ischemia, and medical comorbidities were frequently present at diagnosis. Although most patients (81%) met criteria for "probable DHF" by recently proposed clinical criteria, only half of patients met European criteria in which evidence of abnormal function/filling is required. The 1-, 2-, and 3-year mortality rates were 29%, 39%, and 60%, respectively. Angiotensin-converting enzyme inhibition (P = .0008) and beta-blocker (P = .02) therapy were independently associated with improved survival. Conclusion: This population-based study provides a comprehensive clinical profile, current management, prognosis, and predictors of outcome of patients with new onset CHF who had normal ejection fraction.