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CAD is a Risk Factor for Heart Failure with Preserved Ejection Fraction: The ARIC Study
The 23rd Annual Scientific Meeting HFSA 249 CAD is a Risk Factor for Heart Failure with Preserved Ejection Fraction: The ARIC Study Jenine E. John1, Brian Claggett1, Hicham Skali1, Scott D. Solomon1, Jonathan W. Cunningham1, Kunihiro Matsushita2, Suma H. Konety3, Dalane W. Kitzman4, Thomas H. Mosley5, Donald Clark 3rd5, Patricia P. Chang6, Amil M. Shah1; 1Brigham and Women’s Hospital, Boston, MA; 2Johns Hopkins University, Baltimore, MD; 3 University of Minnesota, Minneapolis, MN; 4Wake Forest School of Medicine, Winston-Salem, NC; 5University of Mississippi Medical Center, Jackson, MS; 6University of North Carolina at Chapel Hill, Chapel Hill, NC Introduction: Coronary artery disease (CAD) is a potent risk factor for heart failure with reduced ejection fraction (HFrEF), and is a common comorbidity in HF with preserved EF (HFpEF). However, data regarding the association of incident CAD with subsequent HFpEF independent of shared comorbidities are limited. Hypothesis: Incident CAD is a risk factor for incident HFpEF independent of common shared comorbidities. Methods: We evaluated 9,902 CAD-free and HF-free participants in the Atherosclerosis Risk in Communities (ARIC) cohort and followed them from 2005 to 2017. Multivariable Cox proportional hazard models were used to assess the association of incident CAD (defined as adjudicated MI or revascularization) with subsequent adjudicated hospitalization for incident HFpEF (EF 50%) or incident HF with mid-range or reduced EF (HFmrEF/HFrEF; EF <50%). CAD and additional covariates (diabetes, hypertension, atrial fibrillation, stroke, smoking, eGFR, BMI) were modeled as time-varying covariates. Model covariates also included age, sex, race, and field center. Separate effect estimates were determined for 0 to 90 days, 90 days to 1 year, and >1 year after CAD diagnosis. Results: The average age as of 2005 was 70 § 6, 61% were female, and 26% were black. During median follow-up of 13 years, incident CAD occurred in 892 participants who subsequently experienced 71 incident HFpEF events and 86 HFmrEF/HFrEF events. Risk of both incident HFpEF and HFmrEF/HFrEF was greatest early following CAD diagnosis. Incident CAD remained predictive of both incident HFpEF (HR 1.9 [1.4 - 2.6]) and HFmrEF/HFrEF (HR 2.8 [2.0 - 3.8]) at >1 year following the CAD event, with no detected effect modification by sex or race (Figure). Similar risks for HFpEF were observed at >1 year following incident MI or following incident revascularization alone. At >1 year after incident CAD, the adjusted incidence rates of HFpEF and HFmrEF/HFrEF were similar (1.10 [95% CI 0.77 - 1.43] and 1.10 [95% CI 0.77 - 1.44] per 100 person-years respectively). Conclusions: Incident CAD is an independent risk factor for subsequent incident HFpEF. At >1 year after incident CAD, incidence of HFpEF is similar to HFmrEF/HFrEF. These findings argue for an important, and potentially under-recognized, role of CAD in the development of HFpEF.
250 Gender Disparity in Acute Heart Failure: Insights from Korean Acute Heart Failure (KorAHF) Registry Ju-Hee Lee, Dae-hwan Bae, Kyung-Kuk Hwang, Myeong-Chan Cho; Chungbuk National University Hospital, Cheongju-si, Republic of Korea Objectives: This study aimed to determine the influences of the gender on baseline characteristics, management, and prognosis in acute heart failure. Backgrounds: Relatively little attention has focused on the gender-related differences in heart failure and women have been underrepresented in clinical trials. Methods: We evaluated the patients hospitalized for acute heart failure in 10 tertiary university hospitals who registered in the Korean Acute Heart Failure (KorAHF) Registry from March 2011 to
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February 2014. Results: We analyzed 5,625 patients (2,632 females). Mean age was 69§14 years old and females were older. Hypertension and valvular heart disease were more prevalent in females, whereas ischemic heart diseases and chronic kidney disease were more prevalent in males. Although females were more severely symptomatic, they were treated in the intensive care unit less frequently and the use of renal replacement therapy, mechanical ventilation and mechanical assist device was low in the female group. During follow-up (29.6§19.2 months), 2,196 patients expired including 269 in-hospital mortality. In the univariate analysis, female gender was not a significant determinant. However, after adjustment of variable factors influencing long-term survival, female gender was a significant prognosticator of the long-term survival [hazard ratio=0.749, 95% confidential interval=0.647-0.867, P<0.001]. Female had more favorable outcome in subgroups with older age (65 years old), chronic kidney disease, cancer, and underweight. Conclusions: There are significant gender-related differences in baseline characteristics, clinical presentation, treatment and prognosis in patients with AHF. After the adjustment of multiple factors affecting long-term survival, females had better survival rate than males.
250 Gender Disparity in Acute Heart Failure: Insights from Korean Acute Heart Failure (KorAHF) Registry Ju-Hee Lee, Dae-hwan Bae, Kyung-Kuk Hwang, Myeong-Chan Cho; Chungbuk National University Hospital, Cheongju-si, Republic of Korea Objectives: This study aimed to determine the influences of the gender on baseline characteristics, management, and prognosis in acute heart failure. Backgrounds: Relatively little attention has focused on the gender-related differences in heart failure and women have been underrepresented in clinical trials. Methods: We evaluated the patients hospitalized for acute heart failure in 10 tertiary university hospitals who registered in the Korean Acute Heart Failure (KorAHF) Registry from March 2011 to
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February 2014. Results: We analyzed 5,625 patients (2,632 females). Mean age was 69§14 years old and females were older. Hypertension and valvular heart disease were more prevalent in females, whereas ischemic heart diseases and chronic kidney disease were more prevalent in males. Although females were more severely symptomatic, they were treated in the intensive care unit less frequently and the use of renal replacement therapy, mechanical ventilation and mechanical assist device was low in the female group. During follow-up (29.6§19.2 months), 2,196 patients expired including 269 in-hospital mortality. In the univariate analysis, female gender was not a significant determinant. However, after adjustment of variable factors influencing long-term survival, female gender was a significant prognosticator of the long-term survival [hazard ratio=0.749, 95% confidential interval=0.647-0.867, P<0.001]. Female had more favorable outcome in subgroups with older age (65 years old), chronic kidney disease, cancer, and underweight. Conclusions: There are significant gender-related differences in baseline characteristics, clinical presentation, treatment and prognosis in patients with AHF. After the adjustment of multiple factors affecting long-term survival, females had better survival rate than males.