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      Significance of Ischemic Heart Disease in Patients With Heart Failure and Preserved, Midrange, and Reduced Ejection Fraction : A Nationwide Cohort Study

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          Abstract

          The pathogenic role of ischemic heart disease (IHD) in heart failure (HF) with reduced ejection fraction (HFrEF; EF <40%) is well established, but its pathogenic and prognostic significance in HF with midrange (HFmrEF; EF 40%-50%) and preserved EF (HFpEF; EF ≥50%) has been much less explored.

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          Most cited references31

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          The perindopril in elderly people with chronic heart failure (PEP-CHF) study.

          John Cleland, Michal Tendera, Jerzy Adamus … (2006)
          Many patients who receive a diagnosis of heart failure have neither a low left ventricular (LV) ejection fraction nor valve disease. Few substantial randomized controlled trials have been conducted in this population, none has focussed on patients with evidence of diastolic dysfunction and none has shown clear benefit on symptoms, morbidity, or mortality. This was a randomized double-blind trial, comparing placebo with perindopril, 4 mg/day in patients aged > or =70 years with a diagnosis of heart failure, treated with diuretics and an echocardiogram suggesting diastolic dysfunction and excluding substantial LV systolic dysfunction or valve disease. The primary endpoint was a composite of all-cause mortality and unplanned heart failure related hospitalization with a minimum follow-up of 1 year. A total of 850 patients were randomized. Their mean age was 76 (SD 5) years and 55% were women. Median follow-up was 2.1 (IQR 1.5-2.8) years. Enrollment and event rates were lower than anticipated, reducing the power of the study to show a difference in the primary endpoint to 35%. Many patients withdrew from perindopril (28%) and placebo (26%) after 1 year and started taking open-label ACE-inhibitors. Overall, 107 patients assigned to placebo and 100 assigned to perindopril reached the primary endpoint (HR 0.919: 95% CI 0.700-1.208; P = 0.545). By 1 year, reductions in the primary outcome (HR 0.692: 95% CI 0.474-1.010; P = 0.055) and hospitalization for heart failure (HR 0.628: 95% CI 0.408-0.966; P = 0.033) were observed and functional class (P < 0.030) and 6-min corridor walk distance (P = 0.011) had improved in those assigned to perindopril. Uncertainty remains about the effects of perindopril on long-term morbidity and mortality in this clinical setting since this study had insufficient power for its primary endpoint. However, improved symptoms and exercise capacity and fewer hospitalizations for heart failure in the first year were observed on perindopril, during which most patients were on assigned therapy, suggesting that it may be of benefit in this patient population.
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            Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy.

            Eric Velazquez, Kerry L Lee, Robert Jones … (2016)
            The survival benefit of a strategy of coronary-artery bypass grafting (CABG) added to guideline-directed medical therapy, as compared with medical therapy alone, in patients with coronary artery disease, heart failure, and severe left ventricular systolic dysfunction remains unclear.
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              Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes.

              Benjamin Steinberg, Xin Zhao, Paul A Heidenreich … (2012)
              Heart failure with preserved ejection fraction (EF) is a common syndrome, but trends in treatments and outcomes are lacking. We analyzed data from 275 hospitals in Get With the Guidelines-Heart Failure from January 2005 to October 2010. Patients were stratified by EF as reduced EF (EF <40% [HF-reduced EF]), borderline EF (40%≤EF<50% [HF-borderline EF]), or preserved (EF ≥50% [HF-preserved EF]). Using multivariable models, we examined trends in therapies and outcomes. Among 110 621 patients, 50% (55 083) had HF-reduced EF, 14% (15 184) had HF-borderline EF, and 36% (40 354) had HF-preserved EF. From 2005 to 2010, the proportion of hospitalizations for HF-preserved EF increased from 33% to 39% (P<0.0001). In multivariable analyses, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at discharge decreased in all EF groups, and β-blocker use increased. Patients with HF-preserved EF less frequently achieved blood pressure control (adjusted odds ratio, 0.44 versus HF-reduced EF; P<0.001) and were more likely discharged to skilled nursing (adjusted odds ratio, 1.16 versus HF-reduced EF; P<0.001). In-hospital mortality for HF-preserved EF decreased from 3.32% in 2005 to 2.35% in 2010 (adjusted odds ratio, 0.89 per year; P=0.01) but was stable for patients with HF-reduced EF (3.03%-2.83%; adjusted odds ratio, 0.93 per year; P=0.10). Hospitalization for HF-preserved EF is increasing relative to HF-reduced EF. Although in-hospital mortality for patients with HF-preserved EF declined over the study period, an important opportunity remains for identifying evidence-based therapies in patients with HF-preserved EF.
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                Author and article information

                Journal
                Title: Circulation: Heart Failure
                Abbreviated Title: Circ Heart Fail
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 1941-3289
                ISSN (Electronic): 1941-3297
                Publication date Created: June 2017
                Publication date (Print): June 2017
                Volume: 10
                Issue: 6
                Affiliations
                [1 ]From the Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Sweden (O.V.); National Heart Centre Singapore (C.S.P.L., A.S.K., T.H.K.T., W.T.T.); Duke-NUS Medical School, Singapore (C.S.P.L., A.S.K.); Regional Cancer Centre Stockholm Gotland, Sweden (L.B.); School of Population Health, University of Western Australia, Perth (T.H.K.T.); Department of Cardiology, Skåne University Hospital, Lund University, Sweden (O.Ö.B.); Department of Medicine, Karolinska...
                Article
                DOI: 10.1161/CIRCHEARTFAILURE.117.003875
                PubMed ID: 28615366
                SO-VID: 6bf24d56-7084-492a-85d6-0d3ecc03b4ee
                Copyright © © 2017
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