Various phenotypes and treatment strategies for heart failure among a contemporary cohort of Egyptian patients

Abstract

Background: Heart failure (HF) is a clinical syndrome characterized by structural and functional cardiac abnormalities. It is classified into three main phenotypes: HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF).
Objective: To evaluate the various phenotypes and treatment strategies for HF among a contemporary cohort of Egyptian patients.
Patients and Methods: This cross-sectional, multi-center study was conducted on 510 HF patients at Al Nasr Hospital in Port Said over 12 months. Patients were grouped based on ejection fraction: HFrEF (43.2%), HFmrEF (23.3%), and HFpEF (33.5%). Data on demographics, comorbidities, medications, and non-pharmacological treatments were collected
Results: Males were predominant in HFrEF (78.6%) while HFpEF was more common among females (35.1%, P < 0.01). Prior HF hospitalization was highest in HFrEF (89.5%, P < 0.001). HFrEF patients had lower eGFR (78 ±26 ml/min, P = 0.003), higher use of beta-blockers (P < 0.001) and angiotensin receptor neprilysin inhibitor (ARNI) (49.5%, P < 0.001), and more frequent revascularization. Sodium-glucose cotransporter 2 (SGLT2) inhibitors were underutilized due to cost (P < 0.001).
Conclusion: HFrEF is more prevalent in males, while HFpEF is more common in females and associated with higher systolic blood pressure (SBP) and left ventricular hypertrophy (LVH). The significant underutilization of SGLT2 inhibitors and ARNI highlights the need for improved accessibility to advanced HF therapies in Egypt. Tailored management strategies are essential for optimizing care based on HF phenotypes.