# Phenotypes and Clinical Outcome of Heart Failure With Preserved Ejection Fraction Patients in China: Findings From the Chinese Cardiovascular Association Database‐Heart Failure Center Registry

## TL;DR

This study analyzed 51,466 Chinese HFpEF patients to find that clinical outcomes vary significantly across five phenotypic subgroups, suggesting the need for personalized treatment strategies.

## Contribution

The study introduces a novel classification system for HFpEF and identifies distinct clinical outcomes across five phenotypes using a large Chinese patient registry.

## Key findings

- Patients with right heart/pulmonary-related, valvular/rhythm-related, and extracardiac disease-related HFpEF had higher adverse outcomes.
- Right heart/pulmonary-related and valvular/rhythm-related phenotypes were linked to increased heart failure rehospitalization.
- Extracardiac disease-related HFpEF was associated with higher cardiovascular mortality.

## Abstract

Heart failure with preserved ejection fraction (HFpEF) is a highly heterogeneous syndrome that poses challenges for therapeutic development and contributes to suboptimal patient outcomes. The phenotypic classification of patients with HFpEF to guide etiology‐specific therapeutic strategies represents a rational approach to address the current dilemma. However, the clinical outcomes of HFpEF under different etiological classifications remain poorly understood. Here, we assessed the clinical outcomes of HFpEF patients across different etiological phenotypes, based on a novel classification system comprising five categories: vascular‐related, cardiomyopathy‐related, right heart/pulmonary‐related, valvular/rhythm‐related, and extracardiac disease‐related HFpEF. Data from the Chinese Cardiovascular Association Database‐Heart Failure Center Registry (2017–2021) were analyzed, including 51,466 hospitalized HFpEF patients with 1‐year follow‐up. Significant differences in baseline characteristics and clinical outcomes were observed among phenotypes. Patients with right heart/pulmonary‐related, valvular/rhythm‐related, and extracardiac disease‐related HFpEF showed a higher incidence of adverse outcomes. Specifically, the right heart/pulmonary‐related and valvular/rhythm‐related phenotypes were associated with increased heart failure rehospitalization, while extracardiac disease‐related HFpEF was linked to higher cardiovascular mortality. Prognostic risk factors also varied across phenotypes. In conclusion, 1‐year outcomes exhibit significant variations across HFpEF phenotypic subgroups. Future studies should explore whether phenotype‐specific personalized treatment strategies can improve clinical outcomes, especially in high‐risk phenotypes.

Structured graphical abstract‐text element

Key Question

It remains unclear whether patients with heart failure with preserved ejection fraction (HFpEF) in different phenotypes also have various clinical outcomes.

Key Finding

Significant differences existed in baseline characteristics and outcomes among different phenotypes; patients with HFpEF‐3 (right heart and pulmonary‐related HFpEF), HFpEF‐4 (valvular‐ and rhythm‐related HFpEF), and HFpEF‐5 (extracardiac disease‐related HFpEF) exhibited a high incidence of adverse outcomes.

Take‐Home Message

One‐year outcome differs among HFpEF patients with various phenotypes. Future studies are warranted to validate whether personalized treatment strategies based on HFpEF phenotypes could improve the individual outcome of HFpEF patients.