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Ischemic risk in patients with heart failure with preserved ejection fraction: A post hoc analysis of the TOPCAT data
Xin He1, Bin Dong1, Weihao Liang1
1Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, PR China; National - Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, PR China.
Insights
Patients with heart failure with preserved ejection fraction (HFpEF) face high ischemic event risk, particularly post-hospitalization. Key risk factors include obesity, prior heart attack, diabetes, and hypertension, with events linked to increased mortality.
Area of Science:
- Cardiology
- Vascular Medicine
- Epidemiology
Background:
- Heart failure with preserved ejection fraction (HFpEF) patients exhibit a high comorbidity burden.
- These comorbidities may increase susceptibility to ischemic vascular events.
- The precise ischemic risk profile in HFpEF remains incompletely understood.
Purpose of the Study:
- To evaluate the incidence and risk factors of ischemic events in HFpEF patients.
- To assess the prognostic significance of these ischemic events on mortality.
Main Methods:
- Analysis of 1767 HFpEF patients from the Americas within the TOPCAT trial.
- Ischemic events defined as myocardial infarction or ischemic stroke.
- Multivariate competing risks regression and time-dependent Cox models were employed.
Main Results:
- A total of 9.3% of patients experienced at least one ischemic event over a median 2.9-year follow-up (3.3% per year).
- Independent risk factors identified: high BMI, prior myocardial infarction, insulin use, peripheral artery disease, hypertension, and smoking.
- Heart failure hospitalization significantly increased ischemic event risk (HR 4.70) within the first month post-discharge.
Conclusions:
- HFpEF patients in the Americas are at substantial risk for ischemic events.
- Ischemic events in this population are associated with increased mortality.
- Baseline characteristics and heart failure hospitalization are predictive of ischemic events.
Background And Aims:
Heart failure with preserved ejection fraction (HFpEF) patients have a high burden of comorbidities that could predispose them to ischemic vascular event. The profile of ischemic risk among HFpEF patients is not fully understood. We aim to evaluate the risk, risk factors, and prognostic significance of ischemic events among HFpEF patients.
Methods:
A total of 1767 HFpEF patients from Americas in the TOPCAT trial were included in our analysis. Ischemic event was defined as myocardial infarction or ischemic stroke during follow-up. Multivariate competing risks regression model was used to identify risk factors of ischemic event. Time-dependent Cox models were constructed to evaluate the association of incident ischemic event and mortality risk.
Results:
During a median follow-up period of 2.9 years, 164 (9.3%) patients had at least 1 ischemic event. The crude incidence rate was 3.3% per year. Body mass index, prior myocardial infarction, insulin use, peripheral artery disease, hypertension, and current smoking were independent risk factors of ischemic event in HFpEF patients. HF hospitalization turned out to be an important trigger of ischemic event. Risk of ischemic event increased 4.7-fold (hazard ratio 4.70, 95% confidence interval: 2.23-9.89, p < 0.001) within the first month after the first HF hospitalization, and dropped rapidly thereafter. Incident ischemic event was associated with significant higher short-term risks of all-cause mortality and cardiovascular mortality.
Conclusions:
HFpEF patients from Americas were at a high risk of ischemic events, which was associated with mortality risk. A subset of baseline characteristics and HF hospitalization during follow-up could predict ischemic event.
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