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Heart failure: A strong-pumping heart may be associated with worse symptoms

A recent study compared the adverse effects of heart failure in patients with preserved and reduced ejection fractions.

Heart failure occurs when a weakened or damaged heart is unable to effectively pump blood around the body. There are two types of heart failure, namely heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. These two types of heart failure are classified based on whether the heart’s ability to contract is impaired.

Heart failure: Reduced vs. preserved ejection fraction

Specifically, patients with reduced ejection fraction have impaired contractile strength whereas patients with preserved ejection fraction do not. Simply put, individuals with preserved ejection fraction have a stronger pumping heart than those with reduced ejection fraction. While both types of heart failure are associated with poor health outcomes, direct comparisons between the two types have not been done.

To compare the presence of other complications and diseases associated with both types of heart failure, Warraich and colleagues analyzed data from the ongoing REHAB-HF clinical trial. Their study included data from 202 patients over the age of 60 years that had been hospitalized for heart failure for at least 24 hours. They published their results in the journal Circulation: Heart Failure.

Both types of heart failure associated with significant impairments

Of the 202 participants, 96 patients were diagnosed with preserved ejection fracture while the remaining 106 were diagnosed with reduced ejection fraction Participants were asked to perform various tests and answer surveys to assess their physical and cognitive impairments, frailty, depression, and overall quality of life.

In summary, the authors found that both types of patients were associated with significant physical and cognitive impairments. More precisely, patients were observed to have impaired mobility, reduced endurance, and a weakened grip. Moreover, it was found that a significant proportion of patients from both groups were considered frail.  In contrast, however, depressive symptoms and a reportedly poorer quality of life were reported to be higher in patients with preserved ejection fraction.

Individuals with heart failure and stronger pumping heart have a poorer quality of life

Overall, the current study highlights the importance of further studying the mechanisms underlying heart failure with preserved ejection fraction and identifying novel strategies to alleviate comorbidities associated with heart failure.

One strategy that might be worth investigating includes physical rehabilitation to help patients regain and improve physical function, including their balance, strength, and stamina. These interventions might not only serve to regain physical function, but rather, increased physical activity could also help improve patient quality of life and alleviate depressive symptoms.

While such interventions might be effective, it is important to recognize that these patients are highly compromised and therefore, rehabilitation should be tailored specifically towards each person in order to reduce the risk of further injury.

Written by Haisam Shah, BSc

Reference: Warraich, H. J., Kitzman, D. W., Whellan, D. J., Duncan, P. W., Mentz, R. J., Pastva, A. M., … & Reeves, G. R. (2018). Physical Function, Frailty, Cognition, Depression, and Quality of Life in Hospitalized Adults≥ 60 Years With Acute Decompensated Heart Failure With Preserved Versus Reduced Ejection Fraction: Insights From the REHAB-HF Trial. Circulation: Heart Failure11(11), e005254.

Haisam Shah BSc
Haisam Shah BSc
Haisam is a first-year Masters student in the Department of Physiology at the University of Toronto. His research involves understanding the role of cardiac fibroblasts in the progressive development of cardiac fibrosis following a myocardial infarction. He graduated from McGill University with a Bachelors of Science – Honors in Pharmacology, where he had the opportunity of investigating potential combination therapies for Glioblastoma Multiforme.


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