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Invited Commentary |

Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction in Women:  Comment on “Mortality Rate in Patients With Diastolic Dysfunction and Normal Systolic Function”

Ileana L. Piña, MD, MPH
Arch Intern Med. 2011;171(12):1088-1089. doi:10.1001/archinternmed.2011.245.
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Heart failure remains the No. 1 discharge diagnosis for Medicare recipients in US hospitals. More than 40% of patients admitted for acutely decompensated heart failure have preserved systolic function (ie, heart failure with preserved ejection fraction [HFPEF]) and DD.1 As therapies for HF with reduced EF improve outcomes, proportionally more patients will present with HFPEF, many of whom will be older women and will have hypertension and/or diabetes mellitus. The in-hospital mortality rate may be low2,3 but after discharge it can be as high as that of patients with impaired systolic function.1,4 Indeed, as well stated by Yip and colleagues,5 diastolic dysfunction is only one of many pathophysiologic derangements in DD and incorrectly may lead the physician to target therapy only to diastole.6,7 As such, HFPEF mechanisms are complex and include metabolic and mechanical abnormalities of systole and diastole. The added effects of hypertension and diabetes mellitus, among comorbidities, cannot be ignored. Yet, the diagnosis of HFPEF usually is made based on symptoms while physicians look to the echocardiographic test results to “seal” the diagnosis of DD.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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