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.