OBJECTIVES: Heart failure with preserved ejection fraction (HFpEF) is considered difficult to diagnose, and hence, poses challenges to understand its epidemiology. This targeted literature review aimed to describe the latest evidence on the incidence and prevalence of HFpEF.

METHODS: EMBASE and Medline databases were searched for relevant English-language publications (Jan’08–Feb’18), which were selected through a two-step screening process: abstract and full-text screening, based on pre-specified inclusion criteria.

RESULTS: Of the 31 included studies, 7 reported incidence and 13 prevalence among the general population; incidence/prevalence of HFpEF in a population with a primary diagnosis of cardiovascular / metabolic disorder was presented in 11 studies. Across the studies, the mean age of study population ranged from 51.6 to 84.2 years. The left-ventricular ejection fraction (LVEF) cut-off threshold used in the studies to define HFpEF varied from 45% to 50%. The cumulative incidence was observed to range from 0.5% to 2.4% (median follow-up of 9 and 8 years, respectively). An incidence study, with data over the last two decades, reported a significant HFpEF increase of 40%. Across the studies, prevalence ranged from 2.8% to 12.9%. Studies reporting age and gender stratified estimates showed significantly higher incidence and prevalence among elderly and females. Patients with cardiovascular disease, diabetes, obesity, renal disease and/or hypertension had higher estimates (as high as 23.9% and 76%, incidence and prevalence, respectively) of HFpEF as compared to the general population.

CONCLUSIONS: In this review, we verified high variability on the estimates, potentially attributable to many factors, namely the study setting and design, study period, differences in the considered LVEF cut-off, baseline age and co-morbidity status of the population. The available evidence suggests an increasing diagnosis and unmet medical need of HFpEF.