Phenotype-Specific Outcome and Treatment Response in Heart Failure with Preserved Ejection Fraction with Comorbid Hypertension and Diabetes: A 12-Month Multicentered Prospective Cohort Study

• Published in: Journal of personalized medicine Vol. 13; no. 8; p. 1218
• Main Authors: Nguyen, Ngoc-Thanh-Van, Nguyen, Hoai-An, Nguyen, Hai Hoang, Truong, Binh Quang, Chau, Hoa Ngoc
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 31.07.2023; MDPI
• Subjects: all-cause mortality; Asia; Cardiovascular disease; Chronic kidney failure; Chronic obstructive pulmonary disease; Cohort analysis; Comorbidity; Congestive heart failure; Coronary artery disease; diabetes; Diabetes mellitus; Diabetes therapy; Diabetics; Heart diseases; Heart failure; heart failure with preserved ejection fraction; Hypertension; Hypertrophy; Kidney diseases; Mortality; Patient outcomes; personalized approach; phenotype; Phenotypes; Precision medicine; Prognosis; Type 2 diabetes; Vietnam; Asia; Vietnam
• ISSN: 2075-4426; 2075-4426
• DOI: 10.3390/jpm13081218

Despite evidence of SGLT2 inhibitors in improving cardiovascular outcomes of heart failure with preserved ejection fraction (HFpEF), the heterogenous mechanism and characteristic multimorbidity of HFpEF require a phenotypic approach. Metabolic phenotype, one common HFpEF phenotype, has various presentations and prognoses worldwide. We aimed to identify different phenotypes of hypertensive-diabetic HFpEF, their phenotype-related outcomes, and treatment responses. The primary endpoint was time to the first event of all-cause mortality or hospitalization for heart failure (HHF). Among 233 recruited patients, 24.9% experienced primary outcomes within 12 months. A total of 3.9% was lost to follow-up. Three phenotypes were identified. Phenotype 1 (n = 126) consisted of lean, elderly females with chronic kidney disease, anemia, and concentric hypertrophy. Phenotype 2 (n = 62) included younger males with coronary artery disease. Phenotype 3 (n = 45) comprised of obese elderly with atrial fibrillation. Phenotype 1 and 2 reported higher primary outcomes than phenotype 3 (p = 0.002). Regarding treatment responses, SGLT2 inhibitor was associated with fewer primary endpoints in phenotype 1 (p = 0.003) and 2 (p = 0.001). RAAS inhibitor was associated with fewer all-cause mortality in phenotype 1 (p = 0.003). Beta blocker was associated with fewer all-cause mortality in phenotype 1 (p = 0.024) and fewer HHF in phenotype 2 (p = 0.011). Our pioneering study supports the personalized approach to optimize HFpEF management in hypertensive-diabetic patients.