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Coronary Artery Disease Doubles Excess Mortality in Patients With Heart Failure With Reduced Ejection Fraction
Nanna Anker1, Kevin K W Olesen1,2, Pernille G Thrane1,2
1Department of Cardiology Aarhus University Hospital Aarhus Denmark.
Insights
Coronary artery disease (CAD) significantly increases mortality in heart failure with reduced ejection fraction (HFrEF) patients. Assessing CAD is crucial for prognosis, as it doubles excess mortality compared to the general population.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Coronary artery disease (CAD) assessment varies globally in heart failure with reduced ejection fraction (HFrEF) patients.
- Limited data exist on the long-term impact of CAD in this population.
- This study investigates the association between CAD and mortality in HFrEF patients undergoing coronary angiography.
Purpose of the Study:
- To examine the association between coronary artery disease (CAD) and all-cause mortality.
- To compare mortality rates between HFrEF patients with and without CAD.
- To compare mortality in HFrEF patients with CAD against a matched general population.
Main Methods:
- Utilized Danish registries to identify HFrEF patients (EF ≤40%) who underwent coronary angiography (2003-2016).
- Estimated 10-year cumulative incidence and adjusted hazard ratios (aHR) for all-cause death.
- Compared HFrEF patients with CAD to those without CAD and to an age/sex-matched general population (1:5 ratio).
Main Results:
- Included 3294 HFrEF patients (44% with CAD) and 16,365 general population individuals.
- Patients with HFrEF and CAD had higher 10-year mortality (55%) than those without CAD (33%).
- CAD presence doubled excess 10-year mortality in HFrEF patients compared to the general population (55% vs. 26%).
Conclusions:
- Coronary artery disease (CAD) presence and extent are strongly linked to mortality in HFrEF patients.
- CAD assessment is vital for improving prognostication in HFrEF.
- Identifying and managing CAD in HFrEF patients can significantly impact long-term outcomes.
Background:
Assessment of coronary artery disease (CAD) in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) varies between countries and there are only limited data on the long-term impact of CAD in these patients. We examined the association between CAD and mortality in patients with HFrEF undergoing coronary angiography.
Methods And Results:
Using Danish registries, we identified patients with HFrEF (EF ≤40%) undergoing coronary angiography from 2003 to 2016. We estimated 10-year cumulative incidence proportions and adjusted hazard ratios (aHR) for all-cause death, comparing patients with HFrEF with CAD with patients with HFrEF without CAD. Both groups were further compared with an age- and sex-matched general population cohort in a 1:5 ratio. We included 3294 patients with HFrEF, of whom 1436 (44%) had CAD, as well as 16 365 matched general population individuals. Median follow-up was 5.3 years. Patients with HFrEF with CAD had higher 10-year mortality than patients with HFrEF without CAD (55% versus 33%; aHR, 1.38 [95% CI, 1.19-1.59]). These estimates were consistent across ages, whereas greater extent of CAD was associated with higher mortality (Ptrend<0.01). Compared with the matched general population, the 10-year excess mortality was 29% for patients with HFrEF with CAD (55% versus 26%; aHR, 2.18 [95% CI, 1.92-2.48]), and 15% for patients with HFrEF without CAD (33% versus 17%; aHR, 1.87 [95% CI, 1.63-2.14]).
Conclusions:
Presence and extent of CAD are strongly associated with all-cause mortality in patients with HFrEF and, when compared with a matched general population, presence of CAD doubles excess mortality. This highlights the importance of CAD assessment for prognostication in patients with HFrEF.
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