Initial Invasive or Conservative Strategy in Heart Failure With Preserved Ejection Fraction and Coronary Artery
Jun Gu1, Jian-An Pan1, Jun-Feng Zhang1
1Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
For heart failure with preserved ejection fraction (HFpEF) and coronary artery disease (CAD), an initial invasive strategy did not improve major clinical outcomes compared to conservative care. However, it did reduce cardiovascular hospitalizations, suggesting a potential benefit for this specific outcome.
Area of Science:
- Cardiology
- Heart Failure Research
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) and heart failure with preserved ejection fraction (HFpEF) often coexist.
- The optimal treatment strategy for patients with both HFpEF and CAD remains uncertain.
Purpose of the Study:
- To compare the clinical outcomes of an initial invasive strategy versus an initial conservative strategy in patients with HFpEF and CAD.
- To determine if an invasive approach offers superior long-term benefits compared to medical therapy alone.
Main Methods:
- Utilized data from a heart failure (HF) cohort study.
- Employed propensity score matching (1:1 ratio) to create comparable groups for invasive and conservative strategies.
- Analyzed a primary composite endpoint of all-cause mortality or cardiovascular hospitalization over a 5-year follow-up.
Main Results:
- No significant difference was observed in the primary composite endpoint between the invasive (57.3%) and conservative (61.1%) strategy groups (P=0.162).
- The initial invasive strategy significantly improved the secondary outcome of cardiovascular hospitalization (P=0.035).
- Medical therapies including antiplatelet agents, ACEI/ARB, and statins were associated with reduced risk of the primary outcome.
Conclusions:
- In patients with HFpEF and CAD, an initial invasive strategy added to medical therapy did not improve the composite of all-cause mortality or cardiovascular hospitalization.
- The findings suggest that while the overall composite outcome was not improved, the invasive approach may reduce cardiovascular hospitalizations.
Background:
In patients with both heart failure with preserved ejection fraction (HFpEF) and coronary artery disease (CAD), whether adopting an initial invasive strategy benefits better in clinical outcomes compared with those who received an initial conservative strategy remains inconclusive.
Methods:
With data from the heart failure (HF) cohort study, we analyzed patients who had HFpEF and CAD amenable to the invasive intervention using propensity score matching of 1:1 ratio to compare the initial invasive strategy and the initial conservative strategy of medical therapy alone. The primary outcome was the composite endpoints of all-cause mortality or cardiovascular hospitalization, and the secondary outcome was all-cause mortality or cardiovascular hospitalization.
Results:
Of 1,718 patients, 706 were treated with the invasive strategy and 1,012 with the conservative strategy initially. Propensity score matching was used to assemble a matched cohort of 1,320 patients receiving the invasive intervention (660 patients) or the medical therapy alone (660 patients). With a follow-up of 5 years, 378 (57.3%) in the invasive-strategy group and 403 (61.1%) in the conservative-strategy group reached the primary endpoint, and there was no significant difference in the rate of the primary endpoint (P = 0.162). The initial invasive strategy only improved the secondary outcome of cardiovascular hospitalization (P = 0.035). Also, the multivariable Cox regression model revealed that antiplatelet therapy, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB), or statin prescription was associated with a decreased risk of the primary outcome.
Conclusion:
In this well-profiled, propensity-matched cohort of patients with HFpEF and CAD, the addition of invasive intervention to medical therapy did not improve the long-term composite of all-cause mortality or cardiovascular hospitalization.
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