FEV1 is a major prognostic factor in diverse heart failure populations: findings from the Global Heart Failure...

Pulmonary abnormalities are commonly reported in heart failure (HF) and may have prognostic implications. Current evidence is limited to high-income countries. We examined the relationship between forced expiratory volume in 1 second (FEV1), HF burden, and long-term clinical outcomes in a diverse multi-national HF cohort.

In a sub-study within the multinational Global Congestive Heart Failure registry, which collected clinical data including spirometry from HF participants in 28 high-, middle-, and low-income countries, and followed for a median 3.8 (IQR 2.1, 5.0) years. Baseline FEV1 was transformed into z-scores standardized for age, sex, and height. The association between baseline FEV1 with all-cause mortality, cardiovascular (CV) deaths, and all-cause hospitalizations was examined.

The analysis included 3359 HF participants (mean age 61.9 [SD 14.1] years, 66.4% males). Participants with lower FEV1 z-scores, even within the normal range (z-score>-2), showed increasing burden of HF, cardiac structural and functional impairment, and lower health-related quality of life. FEV1 z-score ≤ -2 was independently associated with higher risks of all-cause (HR 2.20 [95%CI 1.61-3.01]), CV mortality (HR 2.45 [1.64-3.66]), and hospitalizations (HR 1.40 [1.12-1.74]). The effect sizes were comparable to those of other major prognostic factors. The association was consistent across populations from diverse socio-economic development, HF aetiology, HF types, and airflow obstruction.

In a diverse, multi-national HF cohort, reductions in FEV1 were independently associated with higher HF burden and poor health outcomes. The effect of lower FEV1 was generalizable across the HF spectrum and comparable to other major established HF prognostic factors.