Coronary artery disease and 10-year outcome after hospital admission for heart failure with preserved and with reduced ejection fraction.
AIMS
The prognostic impact of coronary artery disease (CAD) in heart failure is debated. Whereas causes of death have been well described in patients with cardiomyopathy, little is known about how CAD influences causes of death in heart failure with preserved ejection fraction (HFPEF). We undertook a 10-year study and analysed causes of death in relation with CAD in HFPEF and in heart failure with reduced ejection fraction (HFREF).


METHODS AND RESULTS
Our prospective analysis included 591 consecutive patients (320 HFPEF and 271 HFREF) hospitalized for the first time for heart failure during 2000 and followed for 10 years. History of CAD was documented in 25% of HFPEF and 39% of HFREF patients (P < 0.001). Overall, CAD was independently predictive of all-cause and cardiovascular death. CAD had powerful prognostic impact in HFREF [adjusted hazard ratio (HR) 1.60 (1.19-2.15) for all-cause death, and adjusted HR 2.01 (1.38-2.92) for cardiovascular death]. In HFPEF, the association between CAD and cardiovascular death was no longer observed after adjustment [adjusted HR 1.01 (0.69-1.50)]. In HFREF, CAD was associated with increased risk of heart failure-related (adjusted HR 2.03 (1.21-3.43)] and myocardial infarction-related fatal events [adjusted HR 3.84 (1.16-12.7)], while HFPEF patients with CAD appeared at greater risk of sudden death [adjusted HR 2.22 (1.05-4.95)].


CONCLUSION
The prognostic impact of CAD is different in HFPEF compared with HFREF. Patients with HFPEF and CAD are at high risk of cardiovascular death, especially sudden death.
['Rusinaru|Dan|D|', 'Houpe|David|D|', 'Szymanski|Catherine|C|', 'Lévy|Franck|F|', 'Maréchaux|Sylvestre|S|', 'Tribouilloy|Christophe|C|']
D000368:Aged D002423:Cause of Death D003324:Coronary Artery Disease D005260:Female D005500:Follow-Up Studies D005544:Forecasting D005602:France D006333:Heart Failure D006760:Hospitalization D006801:Humans D015994:Incidence D008297:Male D011379:Prognosis D011446:Prospective Studies D013318:Stroke Volume D015996:Survival Rate
Coronary Artery Disease Heart Failure Causes of Death Prognosis