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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
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
publisher
American Heart Association
external identifiers
  • scopus:85021081036
  • wos:000403652100008
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
2018-08-19 04:37:17
@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>},
  articleno    = {e003875},
  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},
  keyword      = {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},
  volume       = {10},
  year         = {2017},
}