Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction
Background Heart failure (HF) with reduced ejection fraction (rEF) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction (pEF) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-06-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.008902 |
| _version_ | 1818398641151279104 |
|---|---|
| author | Louise Y. Sun Jack V. Tu Anan Bader Eddeen Peter P. Liu |
| author_facet | Louise Y. Sun Jack V. Tu Anan Bader Eddeen Peter P. Liu |
| author_sort | Louise Y. Sun |
| collection | DOAJ |
| description | Background Heart failure (HF) with reduced ejection fraction (rEF) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction (pEF) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However, HFpEF outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of HFpEF and HFrEF in women and men following coronary artery bypass grafting. Methods and Results We conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data. HF is captured through a validated population‐based database of all Ontarians with physician‐diagnosed HF. We defined pEF as ejection fraction ≥50% and rEF as ejection fraction <50%. The primary outcome was all‐cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan–Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had pEF without HF, 25.7% had rEF without HF, 6.9% had HFpEF, and 12.0% had HFrEF. Age‐standardized HFpEF mortality rates at 4±2 years of follow‐up were similar in women and men. HFrEF standardized HFpEF mortality rates were higher in women than men. Conclusions We found a higher prevalence and poorer prognosis of HFpEF in women. A history of HF was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow‐up should be focused on women and men with HF rather than on rEF alone. |
| first_indexed | 2024-12-14T07:08:01Z |
| format | Article |
| id | doaj.art-4cd694b40f254353a9a77b784f8069bf |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-14T07:08:01Z |
| publishDate | 2018-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-4cd694b40f254353a9a77b784f8069bf2022-12-21T23:12:04ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-06-0171210.1161/JAHA.118.008902Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection FractionLouise Y. Sun0Jack V. Tu1Anan Bader Eddeen2Peter P. Liu3Division of Cardiac Anesthesiology Department of Anesthesiology and Pain Medicine University of Ottawa Heart Institute Ottawa Ontario CanadaInstitute for Clinical Evaluative Sciences Ontario CanadaInstitute for Clinical Evaluative Sciences Ontario CanadaDivision of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Ontario CanadaBackground Heart failure (HF) with reduced ejection fraction (rEF) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction (pEF) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However, HFpEF outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of HFpEF and HFrEF in women and men following coronary artery bypass grafting. Methods and Results We conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data. HF is captured through a validated population‐based database of all Ontarians with physician‐diagnosed HF. We defined pEF as ejection fraction ≥50% and rEF as ejection fraction <50%. The primary outcome was all‐cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan–Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had pEF without HF, 25.7% had rEF without HF, 6.9% had HFpEF, and 12.0% had HFrEF. Age‐standardized HFpEF mortality rates at 4±2 years of follow‐up were similar in women and men. HFrEF standardized HFpEF mortality rates were higher in women than men. Conclusions We found a higher prevalence and poorer prognosis of HFpEF in women. A history of HF was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow‐up should be focused on women and men with HF rather than on rEF alone.https://www.ahajournals.org/doi/10.1161/JAHA.118.008902coronary artery bypass graft surgeryejection fractionheart failureheart failure with preserved ejection fractionheart failure with reduced ejection fractionmortality |
| spellingShingle | Louise Y. Sun Jack V. Tu Anan Bader Eddeen Peter P. Liu Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary artery bypass graft surgery ejection fraction heart failure heart failure with preserved ejection fraction heart failure with reduced ejection fraction mortality |
| title | Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction |
| title_full | Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction |
| title_fullStr | Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction |
| title_full_unstemmed | Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction |
| title_short | Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction |
| title_sort | prevalence and long term survival after coronary artery bypass grafting in women and men with heart failure and preserved versus reduced ejection fraction |
| topic | coronary artery bypass graft surgery ejection fraction heart failure heart failure with preserved ejection fraction heart failure with reduced ejection fraction mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.008902 |
| work_keys_str_mv | AT louiseysun prevalenceandlongtermsurvivalaftercoronaryarterybypassgraftinginwomenandmenwithheartfailureandpreservedversusreducedejectionfraction AT jackvtu prevalenceandlongtermsurvivalaftercoronaryarterybypassgraftinginwomenandmenwithheartfailureandpreservedversusreducedejectionfraction AT ananbadereddeen prevalenceandlongtermsurvivalaftercoronaryarterybypassgraftinginwomenandmenwithheartfailureandpreservedversusreducedejectionfraction AT peterpliu prevalenceandlongtermsurvivalaftercoronaryarterybypassgraftinginwomenandmenwithheartfailureandpreservedversusreducedejectionfraction |