Phenotyping is the process of characterising HF beyond ejection fraction (EF), using clinical features, biomarkers, and imaging to help identify underlying causes of HF.5 This deeper understanding provides a clearer view of the pathophysiological mechanisms driving HF in each individual patient.6,7
HF phenotypes differ in their clinical features and underlying causes:3
*Based on the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic HF;2
†Derived from a prospective, observational study of 9,134 patients with HF in the ESC Heart Failure Long-Term Registry. Countries included Lithuania and Sweden (northern countries); Bosnia and Herzegovina, Bulgaria, the Czech Republic, Hungary, Latvia, Poland, Romania and Slovakia (eastern countries); Austria and France (western countries); Greece, Italy, Portugal, Serbia, Slovenia, Spain and Turkey (southern countries); Israel (Middle East), and Egypt (North Africa).8
HF is not a single condition – symptoms, causes, and progression can vary widely between phenotypes2,7Managing HF symptomatically, without investigating underlying causes, may lead to missed opportunities for targeted, disease-specific therapy5,11,12By identifying the root cause of HF, phenotyping moves away from a “one size fits all approach”5 and enables more precise and personalised management, as well as facilitating timely treatment and earlier intervention1,2,12
For example, in high-risk patients with HFpEF or HFmrEF aged ≥60 years, the prevalence of transthyretin-mediated amyloidosis with cardiomyopathy (ATTR-CM) in Europe may be as high as 24%‡13
In patients with HF due to ATTR amyloidosis, median survival can be as short as 2.6 years from diagnosis14
As such, early disease identification, through phenotyping HF, can help improve patient outcomes1,4
‡Europe: 24% (95% CI: 18.2–30.2), comprised of Italy: 41% (95% CI: 23.7–59.4; 13/32); United Kingdom: 40% (95% CI: 19.1–64.0; 8/20); France: 29% (95% CI: 10.3–56.0; 5/17); Spain: 20% (95% CI: 13.1–29.0; 22/109); Poland: 6% (95% CI: 0.8–20.8; 2/32). "High risk" criteria included age ≥60 years with a history of HF, LVEF >40%, an end-diastolic interventricular septum thickness ≥12 mm, but without diagnosed amyloidosis, history of LVEF ≤40%, cardiomyopathy of known cause, severe valvular, or coronary heart disease.13
See the ATTR-CM diagnostic pathway
A multi-modal approach to HFpEF phenotyping may improve diagnostic accuracy of underlying conditions such as ATTR-CM:5,6,18,19
Clinical features2,19
Biomarkers2,5,19
Imaging2,19
