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Impact of CAD in Women With Newly Diagnosed HFrEF
Quick Takes
- The prognosis of women with CAD and HF continues to differ from men with similar disease.
- Mortality is affected in women with CAD and HFrEF and CAD.
- Women continue to be under-represented in clinical trials focusing on HFrEF.
Study Questions:
What is the prognostic value of women who have new heart failure with reduced ejection fraction (HFrEF) and coronary artery disease (CAD)?
Methods:
This is an observational cohort study based on the Western Denmark Heart Registry in Western Denmark. HFrEF was defined as patients with a left ventricular ejection fraction (LVEF) ≤40%, who were referred for first-time elective coronary angiography (CAG) with the referral diagnosis being HF between January 1, 2003 to December 31, 2016. Patients were excluded if they: were <18 years old; underwent nonelective procedures; had any other indication for CAG than cardiomyopathy; had LVEF <10%; had a history of myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting; or if the patient died or emigrated within the first 30 days after the index CAG. Presence of CAD was defined as obstructive CAD (≤50% stenosis in ≥1 coronary vessel) or diffuse CAD (1-49% stenosis in >1 coronary vessel). Absence of CAD was defined as no CAD in all coronary vessels or mild nonobstructive CAD in a single vessel by CAG. All-cause death was assessed.
Results:
Out of 54,186 patients, 3,294 had newly diagnosed HF with LVEF 10-40% and underwent CAG as part of their workup of HF. Of these, 27% were female. Women were younger than men at time of CAG but both groups had a median LVEF of 30%. Approximately 31% of females had CAD by CAG but men tended to have multivessel CAD. The 10-year cumulative incidence of all-cause mortality was 41.8% (95% confidence interval [CI], 39.5-44.3) in the entire HFrEF cohort.
Females had a 15% relatively lower 10-year mortality than men (37% vs. 44%; adjusted hazard ratio [aHR], 0.85; 95% CI, 0.73-0.99). Patients with HFrEF and three-vessel disease had the highest 10-year mortality: 59% for women (95% CI, 40%-78%) and 69% (95% CI, 62%-78%) for men. Finally, there was no difference between men and women in 10-year mortality among patients with CAD treated with revascularization within 6 months following the index CAG (aHR, 1.03; 95% CI, 0.70-1.52).
Conclusions:
In patients with HFrEF, the presence of CAD has a significantly greater impact on mortality among women than among men.
Perspective:
Women continue to be under-represented in clinical trials for HFrEF. The present study assessed mortality differences between women and men with newly diagnosed HFrEF referred for evaluation of CAD. The presence of CAD has a greater prognostic impact in women compared to men with newly diagnosed HFrEF.
Clinical Topics: Heart Failure and Cardiomyopathies, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure
Keywords: Coronary Artery Disease, Heart Failure
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