Hospitalization for heart failure in stable coronary artery disease outpatients: determinants, role of interim myocardial infarction, and prognosis

  • Lamblin N
  • Meurice T
  • Tricot O
  • et al.
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Abstract

Background. There is a lack of recent data on incidence, correlates, and prognosis associated with the development of heart failure (HF) in patients with stable coronary artery disease (CAD). Objectives: To analyze the risk of hospitalization for HF, together with relevant associated factors, and related mortality, in stable CAD outpatients. Methods: The multicenter CORONOR registry enrolled 4184 unselected outpatients with stable CAD (ie myocardial infarction (MI) and/or coronary revascularization >1 year previously). Five‐year clinical follow‐up was achieved for 3785 (98%) of the 3781 patients who had no history of hospitalization for HF at inclusion. Results: Hospitalization for HF occurred in 6.1% of the patients at 5‐year and was a powerful predictor of mortality in a time‐dependent analysis (age and sex adjusted HR=7.62 [6.0‐9.68]; P<0.0001). Six variables were independently associated with hospitalization for HF: left ventricular ejection fraction (LVEF), age, diabetes mellitus, atrial fibrillation, history of hypertension, and low estimated glomerular filtration rate. As most patients had a normal LVEF at inclusion (mean=59+/‐10%; 86% with LVEF >= 50%), although low LVEF was a strong predictor of hospitalization for HF, a majority of them (62%) occurred in patients with preserved LVEF. Interim MI was strongly associated with hospitalization for HF (HR=3.63 [2.17‐6.08]; P<0.0001) but was a relatively rare circumstance (7.6% of the patients hospitalized for HF). Conclusions: HF development remained relatively frequent in patients with stable CAD and was associated with a high risk of mortality. Although the LVEF at inclusion was a strong predictor of HF, we emphasized that the majority of cases of HF occurred in patients with preserved LVEF at inclusion and without an interim MI. (Figure presented).

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Lamblin, N., Meurice, T., Tricot, O., De Groote, P., Lemesle, G., & Bauters, C. (2017). Hospitalization for heart failure in stable coronary artery disease outpatients: determinants, role of interim myocardial infarction, and prognosis. Archives of Cardiovascular Diseases Supplements, 9(2), 207. https://doi.org/10.1016/s1878-6480(17)30512-8

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