A Bibliometric Analysis of Heart Failure with Preserved Ejection Fraction From 2000 to 2021

https://doi.org/10.1016/j.cpcardiol.2022.101243Get rights and content

Abstract

Heart Failure with preserved Ejection Fraction (HFpEF) is a heterogeneous disease, which is becoming a worldwide menace. By retrieving the relevant literature of HFpEF from 2000 to 2021, qualitative and quantitative evaluations are carried out to visualize the scientific achievements in this field. The data were from the Web of Science Core Collection database. The bibliometric tool-CiteSpace is used for scientific econometric analysis to understand the development of disciplines and research hotspots in this field. A total of 6318 HFpEF-related research papers were collected by Web of Science Core Collection database from 2000 to 2021, and the number of published papers and citations were in the rising stage. Fund-funded publications accounted for 80.4 percent of total publications, mainly at the national level, with the largest number being funded by the United States Department of Health and Public Services. The number of publications and centrality of the USA ranked first, indicating that the USA is mature in this research field and is in a leading position in the industry, which may benefit from the contributions of scientific research institutions such as Mayo Medical Center, Brigham Women's Hospital, Northwest University and Duke University. Low-income and middle-income countries lag far behind developed countries in terms of health care and scientific research and need to strengthen international cooperation. Bibliometric analysis shows that the main research directions of HFpEF are epidemiology, treatment, and comorbidity research of HFpEF and atrial fibrillation. Chronic microvascular inflammation is the latest research paradigm of HFpEF, especially phosphodiesterase 5 inhibitors.

Introduction

According to Ejection Fraction (EF) values, heart failure(HF) is classified into the following 4 kinds: HF with reduced EF (HFrEF, EF is less than or equal to 40%), HF with improved EF (HFimpEF) (EF is less than or equal to 40% at first, then EF is more than 40%), HF with mid-range EF, (HFmrEF, EF between 40% and 50%), and HF with preserved EF (HFpEF)(EF is more than or equal to50%).1,2 For HFrEF/HFmrEF patients, the guidelines clearly indicate that medication regimens such as Angiotensin converting enzyme inhibitors/Angiotensin receptor-neprilysin inhibitor (ACE-I/ARNI),3, 4, 5 Beta blocker,6,7 Mineralocorticoid receptor antagonist (MRA)8 and Sodium-glucose cotransporter 2 inhibitor (SLGT-2) (Dapagliflozin or Empagliflozin)9,10 could improve the symptoms of patients and reduce the risk of hospitalization and death of patients with HF.

HFpEF is a heterogeneous disease caused by hypertension, diabetes, obesity, coronary artery disease (CAD), chronic kidney disease, other comorbidities, and myocardial amyloidosis.11,12 It has the same signs and symptoms with HF such as dyspnea and lower limb edema, accompanied by structural and/or functional cardiac abnormalities and/or increased natriuretic peptide (NPs), and LVEF ≥ 50%. In HFpEF with sinus rhythm, NT-proBNP > 125pg/mL, BNP > 35pg/mL.When patient has atrial fibrillation (AF), NT-proBNP > 365pg/mL, BNP > 105pg/mL.13,14 HFpEF occurs in 50% of all heart failure patients and is associated with prominent hospitalizations, mortality,15,16 and lower health-related quality of life scores.17 Although the age-specific incidence of HF is declining, the trend of HFpEF is not so obvious compared with HFrEF, and the risk of HFpEF in women is higher than that in men. AF, chronic kidney disease and non-cardiovascular comorbidity are more common in HFpEF, and the proportion of non-cardiovascular disease deaths is higher than that in HFrEF patients,18,19 with the risk of death increasing with the comorbidities burden.20

To date, the recommended treatment is to use diuretics to reduce congestion and improve symptoms, which has been improved in patients with certain HFpEF phenotypes. But there is still no convincing therapy that reduces hospitalizations and mortality.21, 22, 23 The result of EMPEROR-Preserved (Empagliflozin in Patients with Chronic heart failure with Preserved Ejection Fraction)24 showed that SLGT2-Empagliflozin had significant benefits in symptomatic HF patients whose LVEF is greater than 40% and elevated NPs. The role of blood pressure control in preventing HF and reducing other cardiovascular events and HF mortality in patients without generalized baselines is well established. However, the optimal blood pressure target and antihypertensive regimen for patients with HFpEF is unclear.25,26 RAAS antagonists (ACEI, ARB, MRA) may benefit better in patients with an EF approaching 50%.22,27,28

Bibliometric analysis is a literature research method with literature system and bibliometric characteristics as the research objects.29 This approach30 can conduct qualitative and quantitative analysis of literature, evaluate research trends, and show the development frontiers of every fields.31 In addition, the devotion of different countries, institutions, journals, literature, and scholars are compared by this method.32,33 We reviewed the literature on HFpEF based on the Web of Science Core Collection (WOSCC) of Institute for Scientific Information (ISI). CiteSpace (a web-based Java application) is a document visualization analysis software gradually developed for bibliometrics analyses and data visualization,34 which is used to: (1) perform bibliometric analyses of relevant HFpEF-related literature published in the past 20 years; (2) draw visual knowledge maps; (3) display the research status in the HFpEF field; (4) reveal research hotspots and development trends; and (5) provide a reference for future related research.

Section snippets

Data Retrieval and Collection

The database: WOSCC, retrieval strategy: TS = Heart Failure with preserved ejection fraction, Language: English, Document type:Article, Publication Date:2000/01/01-2021/12/31. A total of 6318 articles were retrieved, and the full records and references exported as plain text files were named as download_***.txt. To avoid deviation caused by database update, the data were exported within 1 day (February 19, 2022).

Methods

WOSCC retrieval results were used to conduct statistical analysis on the number of

The Number of Publications and The Analysis of Funding Agencies

Based on the number of publications in each period, we can determine the research development trends and speed of this discipline.36 According to the retrieval strategy, since the 21st century, WOSCC has collected 6318 literatures related to HFpEF, with an average annual publication volume of 287 and a total citation of 78,266 times (self-citation removed). The average citation times of each article was 23.18 times, and the H-index value was 179. H-index is an important indicator of a

Discussion

The WOSCC system is the most famous database of scientific publications regarding many investigations. According to the literature screening strategy mentioned earlier, 6318 literatures about HFpEF in the past 2 decades were extracted from WOSCC, with a total of 91,064 references. The literature funding institutions were mainly at the national level, which indicated that the popularity of this research field continued to increase, and scholars' attention was increasing.

Cooperation between

Limitations

This study has certain limitations. Firstly, the analysis of this study is based on articles from WOSCC database, which is the most widely utilized database of scientific publication, but other databases such as PubMed and Scopus may provide a wider coverage. Secondly, CiteSpace cannot completely replace system retrieval. For example, with the continuous updating of WOSCC literature, the number of documents obtained is different from the actual number of documents, and the number of citations

Conclusion

Through information visualization technology, the research progress, hotpots, and frontiers of HFpEF in the past 2 decades are expounded. These findings provide information for HFpEF investigations and identify potential partners for interested researchers. The study on HFpEF is on the rise, and the number of citations is increasing year by year. Compared with developing countries, developed countries have carried out more HFpEF studies, suggesting that we should strengthen international

Summary

The manuscript summarizes the latest progress, hotspots as well as frontiers, future research development trends and references in this field.

Author Contributions

XueSong Zhang and Yu Zhou designed the study and co-wrote the manuscript. Namin Wei and Xintian Shou collected the data. Shaowei Fan and Yaping You re-examined the data. XueSong Zhang and Yuan Li analyzed the data. Yuanhui Hu reviewed and revised the manuscript. All authors contributed to the article, approved the submitted version, and agree to be held responsible for all aspects of the work.

Authors’ Information

XueSong Zhang, Shaowei Fan and Yaping You are PhD students at Guang 'anmen Hospital, China Academy of Traditional Chinese Medicine, thier main research direction is TCM prevents heart failure.

Yu Zhou and Yuan Li are PhD students at Shanxi University of Chinese Medicine, their main research direction is the basic and clinical research of cardiovascular diseases.

Namin Wei and Xintian Shou are PhD students at Beijing University of Chinese Medicine, their research direction is the basic and

Acknowledgments

The authors acknowledge Home for Researchers editorial team (www.home-for researchers.com) for language editing service.

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    The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

    Funding: This work was supported by National Natural Science Foundation of China (No.82074409).

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