Heart failure etiology impacts survival of patients with heart failure

The impact of heart failure (HF) etiology on prognosis of HF is not well known.

3078 patients (median age 75 years, 61% male) hospitalized with HF were studied. Patients were classified into six etiology groups: hypertension (HTN, 13.9%), ischemic heart disease (IHD, 42.4%), valvular disease (VHD, 9.5%), dilated cardiomyopathy (DCM, 7.9%), other (11.5%), and unknown etiology (14.8%). Patients with normal left ventricular ejection fraction (LVEF) were also included. Follow-up was up to 5 years.

In multivariable analysis, with HTN as the reference, VHD showed the highest risk, HR 1.71 (CI: 1.3-2.2, p<0.0001), followed by DCM, HR 1.66 (CI: 1.2-2.3, p=0.002), IHD, HR 1.4 (CI: 1.1-1.7, p=0.001), and unknown etiology, HR 1.4 (CI: 1.1-1.7, p=0.007). For HF of IHD mortality risk was greater for patients with LVEF<30% (HR 2.1, CI: 1.7-2.7, p<0.0001) than for patients with LVEF ≥ 30% (HR 1.3, CI: 1.0-1.5, p=0.03), compared to the reference (p-value for interaction<0.001).

HF due to VHD, DCM and IHD carry a worse prognosis than that of HTN. For the IHD the risk increases progressively with lower values of LVEF.