Prevalence and Phenotypic Clusters of Heart Failure with Preserved Ejection Fraction (HFpEF): A Prospective Observational Cohort Study from a Tertiary Care Centre

Abstract

Background:
Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases worldwide and is characterized by marked clinical, metabolic, and echocardiographic heterogeneity. This diversity has limited the effectiveness of uniform therapeutic strategies. Identification of distinct phenotypic clusters may improve risk stratification and enable individualized management.

 Objectives:
To determine the prevalence of HFpEF and to identify distinct phenotypic clusters among patients presenting to a tertiary care center in eastern India.

 Methods:
This was a prospective observational cohort study conducted over a 12-month period at a tertiary care teaching hospital. Consecutive adult patients diagnosed with HFpEF based on guideline-recommended criteria were enrolled. Detailed demographic, clinical, laboratory, electrocardiographic, and echocardiographic data were collected. Unsupervised cluster analysis using key clinical and echocardiographic variables was performed to identify distinct HFpEF phenotypes.

 Results:
HFpEF constituted a substantial proportion of heart failure admissions during the study period. The mean age of patients was 63.4 ± 9.8 years, with a predominance of females. Hypertension (78%), diabetes mellitus (46%), and obesity (41%) were the most common comorbidities. Echocardiography demonstrated preserved systolic function with significant diastolic dysfunction, left atrial enlargement, and increased left ventricular mass. Cluster analysis identified three distinct phenotypes: a metabolic–obese phenotype, a hypertensive–atrial remodeling phenotype, and a cardiorenal–high-risk phenotype. These clusters differed significantly in metabolic burden, renal function, atrial size, diastolic indices, functional status, and hospitalization trends.

 Conclusion:
HFpEF is a prevalent and heterogeneous condition in the tertiary care setting. Phenotypic clustering reveals clinically meaningful subgroups with distinct structural remodeling and disease severity, underscoring the limitations of a uniform treatment approach.

 Recommendation:
Routine phenotype-based assessment of HFpEF patients should be encouraged to facilitate personalized management strategies and improve clinical outcomes.