Which is worse diastolic or systolic heart failure

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Abstract

Background/purpose

There is a lack of long-term follow-up studies for elderly patients with heart failure (HF) in primary health care. There is conflicting information on prognostic differences between systolic or diastolic HF in elderly patients. Our aims were, first, to study the association between overall HF or types of HF and all-cause and cardiovascular mortality, and second, to explore the impact of N-terminal prohormone of brain natriuretic peptide (NTproBNP) and comorbidities.

Methods

A longitudinal, prognostic, observational primary health care study with 10 years of follow-up comparing an elderly patient population with HF (systolic and/or diastolic HF) to patients without HF was conducted. HF was diagnosed with echocardiography according to the European Society of Cardiology guidelines.

Results

Seventy-seven of 144 patients (102 women and 42 men; mean age, 77 years) had systolic and/or diastolic HF and were compared with 67 patients without HF (Reference group). During the 10-year follow-up, 71 (49%) patients died (women, 68%; men, 32%). In univariate Cox regression analysis, significant associations were found for overall HF [hazard ratio (HR), 1.86; 95% confidence interval (CI), 1.15–3.01], isolated systolic HF (HR, 1.95; 95% CI, 1.06–3.61), and combined (systolic and diastolic) HF (HR, 3.28; 95% CI, 1.74–6.14) with all-cause mortality, but not for isolated diastolic HF. Similar results were found for cardiovascular mortality. In multivariate analysis, age (HR, 1.11; 95% CI, 1.06–1.17), kidney dysfunction (HR, 1.91; 95% CI, 1.11–3.29), smoking (HR, 3.70; 95% CI, 2.02–6.77), and NTproBNP (HR, 1.01; 95% CI, 1.00–1.02) significantly predicted all-cause mortality, but not any type of HF.

Conclusion

Patients diagnosed with systolic HF had a worse prognosis for mortality compared to the reference group, but in patients with diastolic HF the prognosis for mortality was similar with that in the reference group. NTproBNP was a valuable prognostic factor in elderly patients. Emphasis should be placed on kidney dysfunction and smoking/having smoked.

Keywords

elderly

heart failure

primary health care

prognosis

Cited by (0)

Overview

What is diastolic heart failure?

Diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), is a condition in which your heart’s main pumping chamber (left ventricle) becomes stiff and unable to fill properly.

Diastolic heart failure is one of two kinds of left-sided heart failure. The other type is systolic heart failure which reduces the pumping strength of your left ventricle.

What does the left heart ventricle do?

Your heart has four chambers: two chambers on the top (right atrium and left atrium) and two chambers on the bottom (right ventricle and left ventricle). The right ventricle pumps blood only to your lungs. The left ventricle pumps blood to the rest of your body. The left ventricle is the thickest chamber in your heart.

What is the difference between diastolic and systolic?

Diastolic and systolic are the two numbers on a blood pressure reading. Every time your heart squeezes, it pumps out blood to the network of blood vessels known as the circulatory system. The force or pressure of that squeeze is called systolic blood pressure. When your heart rests between beats, the pressure in the arteries is the diastolic blood pressure. This is why your blood pressure has two numbers:

The top number is the systolic blood pressure.
The bottom number is the diastolic blood pressure.

How does diastolic heart failure affect my body?

When the left side of your heart stiffens, your heart:

Can’t relax properly between beats.
Doesn’t fill up with as much blood as it should.
Pumps out less blood to the rest of your body than a healthy heart would.

As a result, you experience symptoms of heart failure. You might feel short of breath or fatigued (tired, no matter how much you rest). Your breathing may get worse at night when you try to lay flat. You may also notice swelling in your belly or legs (edema). These symptoms might get worse over time.

Diagnosis and Tests

How is diastolic heart failure diagnosed?

Your healthcare provider asks you about your symptoms and family health history. Your provider also conducts a physical exam and listens to your heart with a stethoscope.

You may have specific tests to diagnose heart failure, such as:

Chest X-ray to take images of your chest and heart.
Electrocardiogram (EKG), a record of the electrical activity in your heart.
Echocardiogram, using sound waves to evaluate the structure and function of your heart muscle and valves.
Exercise stress test, increasing your heart rate with medicine or as you walk on a treadmill to see how your heart responds.
Cardiac catheterization, using a catheter (thin, hollow tube) to measure your heart’s pressure and blood flow.

Management and Treatment

How is diastolic heart failure treated?

Your healthcare provider may advise you to make specific lifestyle changes. Healthy habits can improve your cardiovascular health and help your heart work more efficiently. You may feel better if you:

Achieve and maintain a healthy weight.
Eat a low-sodium heart failure diet.
Treat high blood pressure.
Wear a CPAP machine if you have sleep apnea.
Exercise for at least 30 minutes most days of the week.
Quit smoking and using tobacco products. Ask your provider for help with quitting if needed.

Your treatment plan may also include prescription medications. It’s important to take the medication exactly as directed.

Many people with HFpEF take medications for other heart conditions. Your provider might prescribe medications specifically for diastolic heart failure that include:

Diuretics to help your body get rid of excess sodium and water.
Mineralocorticoid receptor antagonists to help your body get rid of extra sodium while keeping potassium.
Medications to lower blood pressure.

Is there a cure for diastolic heart failure?

There is no cure for diastolic heart failure. Proper treatment can help you manage symptoms and improve your heart’s function.

Prevention

How can I reduce my risk of diastolic heart failure?

The best way to reduce your risk of developing diastolic heart failure is to adopt healthy habits. These habits can improve your overall heart health. They decrease your risk of heart problems.

You can reduce your risk of diastolic heart failure by:

Eating a heart-healthy diet.
Exercising regularly.
Limiting alcohol intake and avoiding smoking.
Managing conditions like diabetes, high blood pressure and high cholesterol.

Outlook / Prognosis

What is the outlook for people with diastolic heart failure?

With treatment, you can live well with diastolic heart failure. It’s important to follow your healthcare provider’s treatment plan. Diastolic heart failure doesn’t go away, but you can manage the symptoms.

Living With

What else should I ask my healthcare provider?

You may want to ask your healthcare provider:

What can I do to prevent heart failure from progressing?
What foods should I avoid with diastolic heart failure?
What can I do to manage medication side effects?
How often do I need to see my healthcare provider for diastolic heart failure?

A note from Cleveland Clinic

Diastolic heart failure is one of the two types of left-sided heart failure. HFPEF is the same condition. Your risk of diastolic heart failure increases as you get older. You may also have a higher risk if you have underlying conditions such as diabetes or high blood pressure. Diastolic heart failure doesn’t have a cure, but you can manage the symptoms by changing your lifestyle or taking heart medications. Many people live a full and active life with diastolic heart failure.

What is the main difference between systolic and diastolic heart failure?

Heart failure usually falls into two categories: systolic and diastolic. With systolic heart failure, your heart isn't contracting well during heartbeats. While diastolic heart failure, by contrast, is when your heart can't relax normally between beats.

Is congestive heart failure systolic or diastolic?

There is increasing recognition that disorders of both left ventricular systolic and diastolic function can result in congestive heart failure. As such, consideration of both the filling and emptying characteristics of the left heart is needed to evaluate the hemodynamic abnormalities present in this syndrome.

What is severe systolic or diastolic?

If you have systolic heart failure, it means your heart does not contract effectively with each heartbeat. If you have diastolic heart failure, it means your heart isn't able to relax normally between beats. Both types of left-sided heart failure can lead to right-sided heart failure.

Is diastolic heart failure progressive?

During follow-up, systolic and diastolic dysfunction occur and are associated either systolic pump or diastolic filling failure. In the presence of congestive symptoms the time course of heart failure may become progressive and may end with sudden cardiac death or intractable end-stage failure.