OBJECTIVES: To model clinical outcomes in a cohort of patients with symptomatic HFpEF over a lifetime horizon.

METHODS: We constructed a Markov model with health states for stable HF, HF hospitalization, and death to follow a cohort of patients with HFpEF over their lifetime. Transition probabilities were derived from incidence rates of HF hospitalization, cardiovascular death, and non-cardiovascular death reported in three recent phase 3 HFpEF trials, as weighted averages of reported incidence rates in control arms and SGLT2 inhibitor-treated arms. Hyperkalemia and composite renal endpoint events, defined as sustained estimated glomerular filtration rate (eGFR) decline of ≥40% or end-stage renal disease (ESRD), were also estimated from clinical trial outcomes. Standard care was informed by treatments patients received at baseline in clinical trials, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. We assumed that 20% of patients would also be on sodium-glucose cotransporter-2 (SGLT2) inhibitors. Rehospitalization rates, age-related mortality, and mortality risk associated with clinical events were derived from published literature.

RESULTS: In a cohort of patients with HFpEF treated with standard care starting at age 72, patients experienced 0.68 cumulative HF hospitalizations on average. In total, 44% of patients were hospitalized at least once for HF, and 33% experienced cardiovascular death. In addition, patients experienced an average of 0.24 hyperkalemia events and 0.14 composite renal endpoint events. From age 72, the model estimated 7.5 additional life years, which was most sensitive to non-cardiovascular mortality, cardiovascular mortality, and mortality risk associated with HF hospitalizations in one-way sensitivity analysis.

CONCLUSIONS: HFpEF is associated with high rates of HF hospitalization and risk of cardiovascular death. Even with newer treatments in HFpEF, there is still significant unmet clinical need. Continuing to optimize care and treatment for HFpEF may reduce the clinical burden for this highly prevalent condition and improve population health.