The burden of preserved ejection fraction heart failure in a real-world Swedish patient population

Figures & data

Figure 1. The study population was comprised of patients with an ICD-10 diagnostic code for heart failure with a confirmed left ventricular ejection fraction of >50%.

Table 1. Pre-index and index comorbidity.

Comorbidity (events)	Pre-index HF-PEF patients (n = 137)*		Index HF-PEF patients (n = 137)*
	n	%	n	%
Hypertension	78	56.9%	76	55.4%
Atrial fibrillation	34	24.8%	52	37.9%
Diabetes	30	21.8%	28	20.4%
MI	20	14.5%	32	23.3%
CAD	37	27.0%	29	21.1%
PVD	10	7.2%	11	8.0%
COPD	16	11.6%	19	13.8%
Stroke	16	11.6%	11	8.0%
Renal disease	6	4.3%	19	13.8%
Mitral regurgitation	4	2.9%	5	3.6%
Dependent edema	7	5.1%	3	2.1%
Bundle branch block	2	1.4%	1	0.7%
Pulmonary crackles	0	0.0%	0	0.0%
Cardiomegaly	0	0.0%	0	0.0%
Pulmonary edema	0	0.0%	5	3.6%

HF-PEF, heart failure-preserved ejection fraction; MI, Myocardial Infarction; CAD, Coronary Artery Disease; PVD, Peripheral Vascular Disease; COPD, Chronic Obstructive Pulmonary Disease.

*Total number of patients with HF-PEF encounters at index period.

Table 2. Medications at index and post-index (through study follow-up).

Medications	HF–PEF patients
	Index (n = 137) n (%)	Post-index (n = 131) n (%)
None	17 (12.4)	5 (3.8)
Specific medications
Diuretic	89 (65)	111 (84.7)
Thiazide	13 (9.5)	14 (10.7)
Low-ceiling nonthiazide	0 (0)	0 (0)
High-ceiling loop diuretic	71 (51.8)	98 (74.8)
Potassium-sparing	17 (12.4)	54 (41.2)
Potassium-sparing and low/high-ceiling	5 (3.6)	2 (1.5)
Diuretics in combination*	7 (5.1)	8 (6.1)
Beta blocker	72 (52.5)	94 (71.8)
Non-selective	11 (8)	7 (5.3)
Selective	63 (46)	88 (67.2)
Beta blockers in combination*	1 (0.7)	1 (0.8)
ACE inhibitor	52 (37.9)	73 (55.7)
Vasodilator	36 (26.2)	56 (42.7)
Calcium channel blocker	41 (29.9)	42 (32)
Statin	34 (24.8)	47 (35.9)
Cardiac glycoside	21 (15.3)	34 (25.9)
ARB	18 (13.1)	27 (20.6)
Alpha blocker	1 (0.7)	3 (2.3)

HF-PEF, heart failure-preserved ejection fraction; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker.

*Combination assessed based on codes (ATC) used for medications in prescription registry.

Table 3. Patient characteristics at index event.

Variable	Level	HF-PEF patients (n = 137)*
Age	Mean (SD)	77.1 (9.1)
	Median (Range)	78 (50, 93)
Gender	Male	55 (40.2)
	Female	82 (59.8)
Follow-up time
Years	Mean (SD)	1.4 (0.6)
	Median (Range)	1.5 (0, 2.5)
n (%)	Less than 1 year	19 (13.9)
	1–2 years	91 (66.4)
	2–3 years	27 (19.7)
Index year, n (%)	2005	35 (25.5)
	2006	102 (74.5)
BMI, n (%)	Underweight (<18.5)	5	3.8%
	Normal (18.5–24.9)	48	36.6%
	Overweight (≥25)	33	25.2%
	Obese	45	34.4%
Blood pressure, mean (SD)	Systolic	143.9	22.2
	Diastolic	77.4	11.7
Systolic BP, n (%)	Normal (<120 mmHg)	11	8.0%
	Pre-HTN (12 0–139 mmHg)	42	30.7%
	Stage 1 HTN (140–159 mmHg)	50	36.5%
	Stage 2 HTN (>159 mmHg)	34	24.8%
Diastolic BP, n (%)	Normal (<80 mmHg)	61	44.5%
	Pre-HTN (80–89 mmHg)	45	32.8%
	Stage 1 HTN (90–99 mmHg)	25	18.3%
	Stage 2 HTN (>99 mmHg)	6	4.4%

HF-PEF, heart failure-preserved ejection fraction; BMI, body mass index.

*Total number of patients with HF-PEF encounters at index.

Figure 2. The average cost per follow-up year per HF-PEF patient for key cost categories. SEK to EUR conversions are based on conversion rate of 1SEK = 0.1048 EUR.

Table 4. Hospitalization and outpatient resource utilization costs (2010 SEK) per year of follow-up.

Resource	Unit cost, SEK (EUR^b)	HF-PEF patients (n = 131)
		Mean number of events (range)	Mean costs in SEK (range)	Mean costs in EUR^b (range)
Hospitalizations
Cardiovascular^a	41,088 (4306)	2.2 (0–73)	89,026.0 (0–2,999,390.9)	9329.9 (0–314,336.2)
Cardiovascular—non-heart failure^a	41,088 (4306)	0.6 (0–26.4)	34,521.2 (0–1086735.8)	3617.8 (0–113,889.9)
Heart failure^a	35,436 (3714)	1.5 (0–73)^c	54,504.8 (0–2,586,802.1)	5712.1 (0–271,096.8)
Outpatient clinical
Cardiac care	3453 (362)	0.4 (0–2.9)	1314.9 (0–10,028.8)	137.8 (0–1051.0)
Gastroenterologic care	1907 (200)	0.0 (0–1.5)	66.1 (0–2818.4)	6.9 (0–295.4)
Infectious disease care	2034 (213)	0.2 (0–9.4)	380.0 (0–19,254.0)	39.8 (0–2017.8)
Internal medicine	3287 (344)	1.5 (0–11.5)	4,940.1 (0–37,703.6)	517.7 (0–3951.3)
Neurologic care	2371 (248)	0.0 (0–0.6)	56.4 (0–1,497.3)	5.9 (0–156.9)
Psychiatric care	2180 (228)	0.1 (0–7.6)	179.3 (0–16,517.3)	18.8 (0–1731.0)
Renal care	2094 (219)	2.4 (0–148.5)	4939.2 (0–310,964.5)	517.6 (0–32,589.1)
Respiratory care	2511 (263)	0.2 (0–4.6)	552.2 (0–11,630.4)	57.9 (0–1218.9)
Surgical care	1358 (142)	0.7 (0–7.1)	919.7 (0–9,586.5)	96.4 (0–1004.7)
Other	1435 (150)	1.1 (0–17.9)	1542.8 (0–25,763.5)	161.7 (0–2700.0)
Primary care
Doctor visit	1554 (163)	0.8 (0–6.1)	1196.0 (0–9,467.6)	125.3 (0–992.2)
Doctor home visit	1699 (178)	0	0	0
Doctor telephone call	1554 (163)	0.0 (0–0.8)	15.1 (0–1,325.0)	1.6 (0–138.9)
Nurse visit	1175 (123)	0.1 (0–4.1)	106.2 (0–4,867.1)	11.1 (0–510.1)
Nurse telephone call	777 (81)	0	0	0
Assistant nurse visit	947 (99)	0.0 (0–0.6)	4.0 (0–531.0)	0.4 (0–55.6)
Other visit	1108 (116)	0.1 (0–2.1)	94.57 (0–2,421.84)	9.91 (0–253.8)
Medications
Cardiac glycoside			27.5 (0–353.0)	2.9 (0–37.0)
Alpha blocker			7.14 (0–377.6)	0.7 (0–39.6)
Statin			391.5 (0–7,769.8)	41.0 (0–814.3)
Diuretic			625.4 (0–13,134.5)	65.5 (0–1376.5)
Beta blocker			591.7 (0–2,842.4)	62.0 (0–297.9)
Calcium channel blocker			191.5 (0–2,176.1)	20.1 (0–228.1)
ACE inhibitor			220.6 (0–1,235.2)	23.1 (0–129.4)
ARB			644.4 (0–4,851.9)	67.5 (0–508.5)
Vasodilator			202.7 (0–1,583.7)	21.2 (0–166.0)

HF-PEF, heart failure-preserved ejection fraction.

^aHospitalization unit costs are the same for all patients and for subsequent hospitalizations.

^bBased on conversion rate 1SEK = 0.1048EUR.

^cIncludes patients with no (zero) hospitalizations.

Appendix A Time to subsequent post-index hospitalizations—HF-PEF patients (n = 131).

Hospitalizations	Median number of days (range)
Cardiovascular
Index to First (n = 79, 60.3%)	304 (158–422)
First to Second (n = 50, 38.2%)	135 (52–305)
Second to Third (n = 32, 24.4%)	97 (40–210)
Third to Fourth (n = 24, 18.3%)	67 (21–139)
Fourth to Fifth (n = 15, 11.4%)	132 (24–N/A)
Heart failure
Index to First (n = 59, 45.0%)	592*
First to Second (n = 32, 24.4%)	300 (110–523)
Second to Third (n = 21, 16.0%)	125 (36–190)
Third to Fourth (n = 14, 10.7%)	67 (28–212)
Fourth to Fifth (n = 7, 5.3%)	132 (55–N/A)

HF-PEF, heart failure-preserved ejection fraction.

*Too few patients reached the end-point to measure median time, but 50.6% patients had the first hospitalization at 592 days from index.

Appendix B All cause and heart failure related mortality.

Mortality	HF-PEF patients (n = 137)*
	Total deaths	% (SE)
Mortality (all cause)
Overall	35	25.5% (0.037)
Within 1 year	19	14% (0.029)
1–2 years	14	10.2% (0.025)
2–3 years	2	1.5% (0.01)
Heart failure mortality
Overall	2	1.5% (0.01)
Within 1 year	1	0.7% (0.007)
1–2 years	1	0.7% (0.007)
2–3 years	0	0% (0)

HF-PEF, heart failure-preserved ejection fraction.

*Number of patients with HF-PEF encounters in the index period.