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- Title
Influence of documented history of coronary artery disease on outcomes in patients admitted for worsening heart failure with reduced ejection fraction in the EVEREST trial.
- Authors
Mentz, Robert J.; Allen, Bradley D.; Kwasny, Mary J.; Konstam, Marvin A.; Udelson, James E.; Ambrosy, Andrew P.; Fought, Angela J.; Vaduganathan, Muthiah; O'Connor, Christopher M.; Zannad, Faiez; Maggioni, Aldo P.; Swedberg, Karl; Bonow, Robert O.; Gheorghiade, Mihai
- Abstract
Aims Data on the prognosis of heart failure (HF) patients with coronary artery disease (CAD) have been conflicting. We describe the clinical characteristics and mode-specific outcomes of HF patients with reduced ejection fraction (EF) and documented CAD in a large randomized trial. Methods and results EVEREST was a prospective, randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with worsening HF and reduced EF. Patients were classified as having CAD based on patient-reported myocardial infarction (MI) or coronary revascularization. We analysed the characteristics and outcomes [all-cause mortality and cardiovascular (CV) mortality/HF hospitalization] of patients with and without documented CAD. All events were centrally adjudicated. Documented CAD was present in 2353 patients (57%). Patients with CAD were older and had more co-morbidities compared with those without CAD. Patients with CAD were more likely to receive a beta-blocker, but less likely to receive an angiotensin-converting enzyme (ACE) inhibitor or aldosterone antagonist (P < 0.01). After risk adjustment, patients with documented CAD had similar mortality [hazard ratio (HR) 1.12, 95% confidence interval (CI) 0.97–1.30], but were at an increased risk for CV mortality/HF hospitalization (HR 1.25, 95% CI 1.12–1.41) due to an increased risk for HF hospitalization (HR 1.26, 95% CI 1.10–1.44). Patients with CAD had increased HF- and MI-related events, but similar rates of sudden cardiac death. Conclusion Documented CAD in patients hospitalized for worsening HF with reduced EF was associated with a higher burden of co-morbidities, lower use of HF therapies (except beta-blockers), and increased HF hospitalization, while all-cause mortality was similar.
- Subjects
CORONARY disease; HEART failure patients; HOSPITAL admission &; discharge; G protein coupled receptors; VASOPRESSIN; HEALTH outcome assessment; CLINICAL trials; HOSPITAL care
- Publication
European Journal of Heart Failure, 2013, Vol 15, Issue 1, p61
- ISSN
1388-9842
- Publication type
Article
- DOI
10.1093/eurjhf/hfs139