Heart failure with preserved, mid‐range, and reduced ejection fraction across health care settings: an observational study

Aims This study aimed to assess the sex‐specific distribution of heart failure (HF) with preserved, mid‐range, and reduced ejection fraction across three health care settings. Methods and results In this descriptive observational study, we retrieved the distribution of HF types [with reduced ejection fraction (HFrEF), mid‐range ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF)] for men and women between 65 and 79 years of age in three health care settings from a single country: (i) patients with screening‐detected HF in the high‐risk community (i.e. those with shortness of breath, frailty, diabetes mellitus, and chronic obstructive pulmonary disease) from four screening studies, (ii) patients with confirmed HF from primary care derived from a single observational study, and (iii) patients with confirmed HF from outpatient cardiology clinics participating in a registry. Among 1407 patients from the high‐risk community, 288 had screen‐detected HF (15% HFrEF, 12% HFmrEF, 74% HFpEF), and 51% of the screen‐detected HF patients were women. In both women (82%) and men (65%), HFpEF was the most prevalent HF type. In the routine general practice population (30 practices, 70 000 individuals), among the 160 confirmed HF cases, 35% had HFrEF, 23% HFmrEF, and 43% HFpEF, and in total, 43% were women. In women, HFpEF was the most prevalent HF type (52%), while in men, this was HFrEF (41%). In outpatient cardiology clinics (n = 34), of the 4742 HF patients (66% HFrEF, 15% HFmrEF, 20% HFpEF), 36% were women. In both women (56%) and men (71%), HFrEF was the most prevalent HF type. Conclusions Both HF types and sex distribution vary considerably in HF patients of 65–79 years of age among health care settings. From the high‐risk community through to general practice to the cardiology outpatient setting, there is a shift in HF type from HFpEF to HFrEF and a decrease in the proportion of HF patients that are women.