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Significance of Ischemic Heart Disease in Patients With Heart Failure and Preserved, Midrange, and Reduced Ejection Fraction A Nationwide Cohort Study
Uppsala University, Sweden; Uppsala Clin Research Centre, Sweden.
National Heart Centre Singapore, Singapore; Duke NUS Medical Sch, Singapore.
National Heart Centre Singapore, Singapore; Duke NUS Medical Sch, Singapore.
Regional Cancer Centre Stockholm Gotland, Sweden.
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2017 (English)In: Circulation Heart Failure, ISSN 1941-3289, E-ISSN 1941-3297, Vol. 10, no 6, e003875Article in journal (Refereed) Published
Abstract [en]

Background-The pathogenic role of ischemic heart disease (IHD) in heart failure (HF) with reduced ejection fraction (HFrEF; EF amp;lt;40%) is well established, but its pathogenic and prognostic significance in HF with midrange (HFmrEF; EF 40%-50%) and preserved EF (HFpEF; EF amp;gt;= 50%) has been much less explored. Methods and Results-We evaluated 42 987 patients from the Swedish Heart Failure Registry with respect to baseline IHD, outcomes (IHD, HF, cardiovascular events, and all-cause death), and EF change during a median follow-up of 2.2 years. Overall, 23% had HFpEF (52% IHD), 21% had HFmrEF (61% IHD), and 55% had HFrEF (60% IHD). After multivariable adjustment, associations with baseline IHD were similar for HFmrEF and HFrEF and lower in HFpEF (risk ratio, 0.91 [0.89-0.93] versus HFmrEF and risk ratio, 0.90 [0.88-0.92] versus HFrEF). The adjusted risk of IHD events was similar for HFmrEF versus HFrEF and lower in HFpEF (hazard ratio, 0.89 [0.84-0.95] versus HFmrEF and hazard ratio, 0.84 [0.80-0.90] versus HFrEF). After adjustment, prevalent IHD was associated with increased risk of IHD events and all other outcomes in all EF categories except all-cause mortality in HFpEF. Those with IHD, particularly new IHD events, were also more likely to change to a lower EF category and less likely to change to a higher EF category over time. Conclusions-HFmrEF resembled HFrEF rather than HFpEF with regard to both a higher prevalence of IHD and a greater risk of new IHD events. Established IHD was an important prognostic factor across all HF types.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2017. Vol. 10, no 6, e003875
Keyword [en]
acute coronary syndrome; heart failure; outcomes; prevalence; registry
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-139190DOI: 10.1161/CIRCHEARTFAILURE.117.003875ISI: 000403652100008PubMedID: 28615366OAI: oai:DiVA.org:liu-139190DiVA: diva2:1120181
Note

Funding Agencies|Swedish National Board of Health and Welfare; Swedish Association of Local Authorities and Regions; Swedish Society of Cardiology; SwedeHF Research Foundation; Swedish Research Council; Swedish Heart-Lung Foundation; Stockholm County Council and Swedish Society of Medicine; Karolinska Institutet Foundation; Mats Kleberg Foundation; National Medical Research Council of Singapore

Available from: 2017-07-05 Created: 2017-07-05 Last updated: 2017-07-05

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Dahlström, Ulf
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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