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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

Vedin, Ola ; Lam, Carolyn S P ; Koh, Angela S. ; Benson, Lina ; Teng, Tiew Hwa Katherine ; Tay, Wan Ting ; Braun, Oscar Ö. LU ; Savarese, Gianluigi ; Dahlström, Ulf and Lund, Lars H (2017) In Circulation: Heart Failure 10(6).
Abstract

Background - The pathogenic role of ischemic heart disease (IHD) in heart failure (HF) with reduced ejection fraction (HFrEF; EF <40%) is well established, but its pathogenic and prognostic significance in HF with midrange (HFmrEF; EF 40%-50%) and preserved EF (HFpEF; EF ≥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... (More)

Background - The pathogenic role of ischemic heart disease (IHD) in heart failure (HF) with reduced ejection fraction (HFrEF; EF <40%) is well established, but its pathogenic and prognostic significance in HF with midrange (HFmrEF; EF 40%-50%) and preserved EF (HFpEF; EF ≥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.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute coronary syndrome, heart failure, outcomes, prevalence, registry
in
Circulation: Heart Failure
volume
10
issue
6
article number
e003875
publisher
American Heart Association
external identifiers
  • scopus:85021081036
  • wos:000403652100008
  • pmid:28615366
ISSN
1941-3289
DOI
10.1161/CIRCHEARTFAILURE.117.003875
language
English
LU publication?
yes
id
e342f434-9f14-48ae-befd-33a203660f8b
date added to LUP
2017-08-17 12:35:35
date last changed
2024-04-14 16:23:15
@article{e342f434-9f14-48ae-befd-33a203660f8b,
  abstract     = {{<p>Background - The pathogenic role of ischemic heart disease (IHD) in heart failure (HF) with reduced ejection fraction (HFrEF; EF &lt;40%) is well established, but its pathogenic and prognostic significance in HF with midrange (HFmrEF; EF 40%-50%) and preserved EF (HFpEF; EF ≥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.</p>}},
  author       = {{Vedin, Ola and Lam, Carolyn S P and Koh, Angela S. and Benson, Lina and Teng, Tiew Hwa Katherine and Tay, Wan Ting and Braun, Oscar Ö. and Savarese, Gianluigi and Dahlström, Ulf and Lund, Lars H}},
  issn         = {{1941-3289}},
  keywords     = {{acute coronary syndrome; heart failure; outcomes; prevalence; registry}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{6}},
  publisher    = {{American Heart Association}},
  series       = {{Circulation: Heart Failure}},
  title        = {{Significance of Ischemic Heart Disease in Patients with Heart Failure and Preserved, Midrange, and Reduced Ejection Fraction : A Nationwide Cohort Study}},
  url          = {{http://dx.doi.org/10.1161/CIRCHEARTFAILURE.117.003875}},
  doi          = {{10.1161/CIRCHEARTFAILURE.117.003875}},
  volume       = {{10}},
  year         = {{2017}},
}