Phenotypes of patients with heart failure with preserved ejection fraction taking into account treatment adherence: a single-center observational study

Aim. To identify phenotypes of patients with heart failure with preserved ejection fraction (HFpEF) aged 60 years and older using cluster analysis based on clinical characteristics and treatment adherence level.

Material and methods. The observational study included 212 outpatients aged ≥60 years diagnosed with HFpEF. Adherence was determined using the Morisky Medication Adherence Scale-4 (MMAS-4) and the National Society for Evidence-Based Pharmacotherapy (NSEPh) adherence scale for patients with noncommunicable diseases. Probable frailty was assessed using the "Age Is Not a Barrier" questionnaire. To identify phenotypes, a cluster analysis was performed using the Ward method with z-scores.

Results. The median MMAS-4 score was 4 [3; 4], while high adherence was recorded in 68,9% of patients. The median NSEPh adherence was 0 [0; 0], while full adherence was recorded in 78,3% of patients. The median "Age Is Not a Barrier" questionnaire score was 1 [0; 3]. No significant relationships between the studied parameters were revealed during the correlation and regression analysis. The optimal number of clusters was 2 as follows: 163 (76,9%) patients in cluster 1, 49 (23,1%) in cluster 2. Patients in group 1 had higher adherence to therapy (p<0,001), visited a doctor more often (p<0,001), and more often had a history of coronary artery disease (p=0,032) and myocardial infarction (p=0,006). Patients in group 2 were older (p=0,016), had a higher risk of probable frailty (p=0,021) and were less informed about current blood glucose (p<0,001) and cholesterol (p=0,001) levels. The groups did not differ significantly in the frequency of drug prescriptions.

Conclusion. High adherence is associated with frequent visits to the doctor and high patient awareness. Patients with non-ischemic HFpEF require additional monitoring and measures to improve treatment adherence.

1. Savarese G, Becher PM, Lund LH, et al. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res.2023;118(17):3272-87. doi:10.1093/cvr/cvac013.

2. Fomin IV, Belenkov YuN, Mareev VYu, et al. EPOCH-CHF As A Mirror of the Current Problems in Cardiovascular Diseases Treatment in Real Clinical Practice. Kardiologiia.2024;64(11):48-61. (In Russ.) doi:10.18087/cardio.2024.11.n2808.

3. Larina VN, Lunev VI. Phenotyping of outpatients with heart failure with preserved ejection fraction and poor prognosis. Russian Journal of Cardiology. 2024;29(3):5759. (In Russ.) doi:10.15829/1560-4071-2024-5759.

4. Ageev FT, Ovchinnikov АG. Treatment of patients with heart failure and preserved ejection fraction: reliance on clinical phenotypes. Kardiologiia. 2022;62(7):44-53. (In Russ.) doi:10.18087/cardio.2022.7.n2058.

5. Vinogradova NG, Polyakov DS, Fomin IV. The risks of re-hospitalization of patients with heart failure with prolonged follow-up in a specialized center for the treatment of heart failure and in real clinical practice. Kardiologiia. 2020;60(3):59-69. (In Russ.) doi:10.18087/cardio.2020.3.n1002.

6. Metra M, Tomasoni D, Adamo M, et al. Worsening of chronic heart failure: definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail.2023;25(6):776-91. doi:10.1002/ejhf.2874.

7. Fomin IV, Vinogradova NG, Polyakov DS, et al. Experience of introducing a new form of organization of medical care for patients with heart failure in the Russian Federation. Kardiologiia.2021;61(3):42-51. (In Russ.) doi:10.18087/cardio.2021.3.n1005.

8. El-Zein RS, Mohammed M, Nguyen DD, et al. Association of Medication Adherence and Health Status in Heart Failure With Reduced Ejection Fraction: Insights From the CHAMP-HF Registry. Circ Cardiovasc Qual Outcomes. 2024;17(9): e010211. doi:10.1161/CIRCOUTCOMES.123.010211.

9. Drapkina OM, Chesnikova AI. Principles of Outpatient Care of Patients With Heart Failure. Kardiologiia.2024;64(11):148-56. (In Russ.) doi:10.18087/cardio.2024.11.n2797.

10. Galyavich AS, Tereshchenko SN, Uskach TM, et al. 2024 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2024;29(11):6162. (In Russ.) doi:10.15829/1560-4071-2024-6162. EDN:WKIDLJ.

11. Tkacheva ON, Kotovskaya YuV, Runikhina NK, et al. Clinical guidelines Frailty. Russian Journal of Geriatric Medicine.2025;1(21):6-48. (In Russ.) doi:10.37586/2686-8636-1-2025-6-48.

12. Smirnova EA, Ponomareva OV, Skiperskikh PV, et al. Clinical and phenotypical profiles of patients with chronic heart failure with preserved ejection fraction. The Russian Journal of Preventive Medicine.2025;28(1):83-8. (In Russ.) doi:10.17116/profmed20252801183.

13. Sieben A, A W van Onzenoort H, J H M van Laarhoven K, et al. Identification of Cardiovascular Patient Groups at Risk for Poor Medication Adherence: A Cluster Analysis. J Cardiovasc Nurs.2021;36(5):489-97. doi:10.1097/JCN.0000000000000702.

14. Semiokhina AS, Taratukhin EO, Bayandin NL, et al. Life Quality in One Year after Myocardial Infraction with Incomplete Revascularization. Russian Journal of Cardiology.2017;(1):102-5. (In Russ.) doi:10.15829/1560-4071-2017-1-102-105.