CAD assessment could aid prognosis of patients with heart failure
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Key takeaways:
- CAD was significantly prognostic of all-cause mortality in patients with heart failure.
- Mortality risk was higher in patients with mildly reduced ejection fraction plus CAD vs. HF with reduced EF and no CAD.
Presence of CAD was prognostic of increased mortality for patients with heart failure, even for those with only mildly reduced ejection fraction, according a study published in the Journal of the American Heart Association.
“In patients with newly diagnosed HF, it is recommended to assess for causes of HF, including CAD, which is present in [approximately] 50% of patients with HF. Despite this, only few studies have assessed the potential impact of CAD on all-cause mortality in patients with HF,” Roni Ranghoej Nielsen, MD, PhD, of the department of cardiology at Aarhus University Hospital in Aarhus, Denmark, and colleagues wrote. “In patients with [left ventricular] EF < 50% and newly diagnosed HF, it remains undetermined whether low LVEF or presence of CAD provides independent prognostic information on mortality.”
Using the Western Denmark Heart Registry, Nielsen and colleagues identified 3,620 patients with newly diagnosed HF and LVEF 10% to 49%, referred for first-time elective coronary angiography between 2003 and 2016. The average patient age was 64 years and nearly three-quarters were men.
Participants were stratified as having HF with reduced EF (10% to 35%) or HF with mildly reduced EF (36% to 49%) and by presence of CAD.
Overall, CAD was present in 44% of the cohort.
After adjusting for age, sex, BP, prior ischemic stroke, peripheral artery disease, diabetes, atrial fibrillation and smoking status, compared with participants with HF with mildly reduced EF and no CAD, 10-year mortality was significantly higher for patients with:
- HFrEF and no CAD (adjusted HR = 1.22; 95% CI, 0.97-1.55);
- HF with mildly reduced EF plus CAD (aHR = 1.55; 95% CI, 1.17-2.05); and
- HFrEF plus CAD (aHR = 1.71; 95% CI, 1.35-2.17).
“The present findings underscore the importance of considering CAD evaluation as an integral component of the clinical risk assessment process for patients with newly diagnosed heart failure,” the researchers wrote. “By incorporating CAD assessment into the risk evaluation, health care professionals can obtain valuable prognostic information that goes beyond LVEF measurement alone; this information can aid in tailoring treatment strategies, improving patient outcomes, and guiding therapeutic decision-making in a more personalized manner.”
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