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Predictors of heart failure in patients with stable coronary artery disease: a PEACE study
Eldrin F Lewis1, Scott D Solomon, Kathleen A Jablonski
1Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass 02115, USA. eflewis@partners.org
Insights
A new risk score effectively predicts heart failure (HF) in patients with stable coronary artery disease and preserved ejection fraction. Trandolapril treatment was found to reduce HF risk in this population.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Risk Stratification
Background:
- Heart failure (HF) is frequently linked to coronary artery disease (CAD).
- Existing risk models for HF primarily target patients post-acute myocardial infarction.
- A need exists for HF risk prediction in stable CAD with preserved ejection fraction (PEF).
Purpose of the Study:
- To develop and validate a risk model for predicting new-onset heart failure (HF) hospitalizations and fatal HF.
- To identify key risk factors for HF in patients with stable coronary artery disease and preserved ejection fraction.
- To assess the impact of trandolapril on HF risk in this specific patient group.
Main Methods:
- Utilized data from 8290 patients in the Prevention of Events with Angiotensin-Converting Enzyme Inhibition trial without pre-existing HF.
- Employed Cox regression multivariable modeling with backward selection to identify significant covariates (P<0.05).
- Developed an integer-based risk score and evaluated its discriminatory power using the c-statistic.
Main Results:
- Twelve baseline characteristics, including older age, hypertension, and diabetes, were independently associated with increased HF risk.
- The developed risk score demonstrated excellent discriminatory power (c-statistic=0.80), ranging from 1.75% to 33% risk.
- Randomization to trandolapril significantly reduced HF risk without interaction with other risk factors.
Conclusions:
- Identified traditional and novel factors independently associated with HF risk in stable CAD patients with PEF.
- Trandolapril demonstrated a significant benefit in reducing HF risk in this patient population.
- The validated risk score provides a valuable tool for stratifying HF risk in patients with stable CAD and PEF.
Background:
Heart failure (HF) is a disease commonly associated with coronary artery disease. Most risk models for HF development have focused on patients with acute myocardial infarction. The Prevention of Events with Angiotensin-Converting Enzyme Inhibition population enabled the development of a risk model to predict HF in patients with stable coronary artery disease and preserved ejection fraction.
Methods And Results:
In the 8290, Prevention of Events with Angiotensin-Converting Enzyme Inhibition patients without preexisting HF, new-onset HF hospitalizations, and fatal HF were assessed over a median follow-up of 4.8 years. Covariates were evaluated and maintained in the Cox regression multivariable model using backward selection if P<0.05. A risk score was developed and converted to an integer-based scoring system. Among the Prevention of Events with Angiotensin-Converting Enzyme Inhibition population (age, 64+/-8; female, 18%; prior myocardial infarction, 55%), there were 268 cases of fatal and nonfatal HF. Twelve characteristics were associated with increased risk of HF along with several baseline medications, including older age, history of hypertension, and diabetes. Randomization to trandolapril independently reduced the risk of HF. There was no interaction between trandolapril treatment and other risk factors for HF. The risk score (range, 0 to 21) demonstrated excellent discriminatory power (c-statistic 0.80). Risk of HF ranged from 1.75% in patients with a risk score of 0% to 33% in patients with risk score >or=16.
Conclusions:
Among patients with stable coronary artery disease and preserved ejection fraction, traditional and newer factors were independently associated with increased risk of HF. Trandolopril decreased the risk of HF in these patients with preserved ejection fraction.
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