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Aims Heart failure with preserved ejection fraction (HFpEF) is a growing public health problem. Its prevalence among heart failure patients increases over time, accounting for at least 50% of all hospital admissions for HF. Nevertheless, no single guideline exists for diagnosis or treatment for HFpEF, and older age or comorbidities are additional factors that confuse etiology and complicate prognosis. Moreover, there are few data regarding the consequences of HFpEF on other recurrent pathologies. To assess the prognostic impact of a pre-existing HFpEF on patients ospidalized for intercurrent episodes of atrial fibrillation (AF) or acute pulmonary embolism (PE). Methods and results We performed a retrospective evaluation of 222 patients, consecutively hospitalized in our unit of Cardiology with a diagnosis of paroxysmal AF or acute PE, from January 2017 to December 2020. We recruited exclusively patients with normal cardiac function and HFpEF patients. Heart failure with reduced FEVS patients were excluded from the study. We have described for each patient the demographic and clinical characteristics, comorbidities, instrumental test results, and clinical outcomes. In order to assess, for each group, the relationship between patient characteristics and clinical outcomes, the Chi-square test or alternatively the Pearson–Spearman correlation coefficients were calculated. The 222 patients studied had an average age of 73.7 years (min. 27, max: 94). 68 AF patients had pre-existing HFpEF, whereas AF patients without HF were 77. Patients with pre-existing HFpEF and newly-onset AF had a more advanced age (76.7 y vs. 72.9 y), and greater comorbidity (meanly 4 vs. 3) rather than AF patients without HFpEF. Moreover, percentage of converting arrhythmia were significantly higher in AF patients without HFpEF. Patients with acute PE and pre-existing HFpEF were 44, whereas PE patients without HF were 33. Acute PE patients with pre-existing HFpEF had older age, a prevalence for female sex, more comorbidities, an average longer hospitalizations, but no significantly different rates of severe complications (ictus, haemorrhagies, needs for ventilation, pulmonary infarction or deaths) rather than PE patients without HFpEF. Conclusions The patients with AF or PE and concomitant HFpEF that were hospitalized from January 2017 to December 2020, showed an average longer hospitalization, a lower percentage of converting arrhythmia, probably due to the older age and the greater comorbidity.

8 Acute pulmonary embolism or paroxysmal atrial fibrillation in patients with heart failure and preserved ejection fraction: prognostic implications