Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease
Abstract Aims Ischaemic coronary artery disease (CAD) remains the leading cause of mortality globally due to sudden death and heart failure (HF). Invasive coronary angiography (CAG) is the gold standard for evaluating the presence and severity of CAD. Our objective was to assess temporal trends in C...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-06-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13875 |
| _version_ | 1811288988548333568 |
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| author | Entela Bollano Björn Redfors Araz Rawshani Dimitrios Venetsanos Sebastian Völz Oskar Angerås Charlotta Ljungman Joakim Alfredsson Tomas Jernberg Truls Råmunddal Petur Petursson J. Gustav Smith Oscar Braun Henrik Hagström Ole Fröbert David Erlinge Elmir Omerovic |
| author_facet | Entela Bollano Björn Redfors Araz Rawshani Dimitrios Venetsanos Sebastian Völz Oskar Angerås Charlotta Ljungman Joakim Alfredsson Tomas Jernberg Truls Råmunddal Petur Petursson J. Gustav Smith Oscar Braun Henrik Hagström Ole Fröbert David Erlinge Elmir Omerovic |
| author_sort | Entela Bollano |
| collection | DOAJ |
| description | Abstract Aims Ischaemic coronary artery disease (CAD) remains the leading cause of mortality globally due to sudden death and heart failure (HF). Invasive coronary angiography (CAG) is the gold standard for evaluating the presence and severity of CAD. Our objective was to assess temporal trends in CAG utilization, patient characteristics, and prognosis in HF patients undergoing CAG at a national level. Methods and results We used data from the Swedish Coronary Angiography and Angioplasty Registry. Data on all patients undergoing CAG for HF indication in Sweden between 2000 and 2018 were collected and analysed. Long‐term survival was estimated with multivariable Cox proportional hazards regression adjusted for differences in patient characteristics. In total, 22 457 patients (73% men) with mean age 64.2 ± 11.3 years were included in the study. The patients were increasingly older with more comorbidities over time. The number of CAG specifically for HF indication increased by 5.5% per calendar year (P < 0.001). No such increase was seen for indications angina pectoris and ST‐elevation myocardial infarction. A normal CAG or non‐obstructive CAD was reported in 63.2% (HF‐NCAD), and 36.8% had >50% diameter stenosis in one or more coronary arteries (HF‐CAD). The median follow‐up time was 3.6 years in HF‐CAD and 5 years in HF‐NCAD. Age and sex‐adjusted survival improved linearly by 1.3% per calendar year in all patients. Compared with HF‐NCAD, long‐term mortality was higher in HF‐CAD patients. The risk of death increased with the increasing severity of CAD. Compared with HF‐NCAD, the risk estimate in patients with a single‐vessel disease was higher [hazard ratio (HR) 1.3; 95% confidence interval (CI) 1.20–1.41; P < 0.001], a multivessel disease without the involvement of left main coronary artery (HR 1.72; 95% CI 1.58–1.88; P < 0.001), and with left main disease (HR 2.02; 95% CI 1.88–2.18; P < 0.001). The number of HF patients undergoing revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) increased by 7.5% (P < 0.001) per calendar year. The majority (53.4%) of HF‐CAD patients were treated medically, while a minority (46.6%) were referred for revascularization with PCI or CABG. Compared with patients treated with PCI, the proportion of patients treated medically or with CABG decreased substantially (P < 0.001). Conclusions Over 18 years, the number of patients with HF undergoing CAG has increased substantially. Expanded utilization of CAG increased the number of HF patients treated with percutaneous coronary intervention and coronary artery bypass surgery. Long‐term survival improved in all HF patients despite a steady increase of elderly patients with comorbidities. |
| first_indexed | 2024-04-13T03:46:57Z |
| format | Article |
| id | doaj.art-6eb4fbc7241449429ac69d75d2edd08d |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-13T03:46:57Z |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-6eb4fbc7241449429ac69d75d2edd08d2022-12-22T03:03:59ZengWileyESC Heart Failure2055-58222022-06-01931812182210.1002/ehf2.13875Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery diseaseEntela Bollano0Björn Redfors1Araz Rawshani2Dimitrios Venetsanos3Sebastian Völz4Oskar Angerås5Charlotta Ljungman6Joakim Alfredsson7Tomas Jernberg8Truls Råmunddal9Petur Petursson10J. Gustav Smith11Oscar Braun12Henrik Hagström13Ole Fröbert14David Erlinge15Elmir Omerovic16Department of Cardiology Sahlgrenska University Hospital Gothenburg 413 45 SwedenDepartment of Cardiology Sahlgrenska University Hospital Gothenburg 413 45 SwedenDepartment of Cardiology Sahlgrenska University Hospital Gothenburg 413 45 SwedenDepartment of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences Linköping University Linköping SwedenDepartment of Cardiology Sahlgrenska University Hospital Gothenburg 413 45 SwedenDepartment of Cardiology Sahlgrenska University Hospital Gothenburg 413 45 SwedenDepartment of Cardiology Sahlgrenska University Hospital Gothenburg 413 45 SwedenDepartment of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences Linköping University Linköping SwedenDivision of Cardiovascular Medicine, Department of Clinical Sciences Danderyd Hospital Stockholm SwedenDepartment of Cardiology Sahlgrenska University Hospital Gothenburg 413 45 SwedenDepartment of Cardiology Sahlgrenska University Hospital Gothenburg 413 45 SwedenDepartment of Cardiology Sahlgrenska University Hospital Gothenburg 413 45 SwedenDepartment of Cardiology Clinical Sciences, Lund University, and Skåne University Hospital Lund SwedenDepartment of Public Health and Clinical Medicine, Umeå University, and Heart Centre Umeå University Hospital Umeå SwedenDepartment of Cardiology, Faculty of Health Örebro University Örebro SwedenDepartment of Cardiology Clinical Sciences, Lund University, and Skåne University Hospital Lund SwedenDepartment of Cardiology Sahlgrenska University Hospital Gothenburg 413 45 SwedenAbstract Aims Ischaemic coronary artery disease (CAD) remains the leading cause of mortality globally due to sudden death and heart failure (HF). Invasive coronary angiography (CAG) is the gold standard for evaluating the presence and severity of CAD. Our objective was to assess temporal trends in CAG utilization, patient characteristics, and prognosis in HF patients undergoing CAG at a national level. Methods and results We used data from the Swedish Coronary Angiography and Angioplasty Registry. Data on all patients undergoing CAG for HF indication in Sweden between 2000 and 2018 were collected and analysed. Long‐term survival was estimated with multivariable Cox proportional hazards regression adjusted for differences in patient characteristics. In total, 22 457 patients (73% men) with mean age 64.2 ± 11.3 years were included in the study. The patients were increasingly older with more comorbidities over time. The number of CAG specifically for HF indication increased by 5.5% per calendar year (P < 0.001). No such increase was seen for indications angina pectoris and ST‐elevation myocardial infarction. A normal CAG or non‐obstructive CAD was reported in 63.2% (HF‐NCAD), and 36.8% had >50% diameter stenosis in one or more coronary arteries (HF‐CAD). The median follow‐up time was 3.6 years in HF‐CAD and 5 years in HF‐NCAD. Age and sex‐adjusted survival improved linearly by 1.3% per calendar year in all patients. Compared with HF‐NCAD, long‐term mortality was higher in HF‐CAD patients. The risk of death increased with the increasing severity of CAD. Compared with HF‐NCAD, the risk estimate in patients with a single‐vessel disease was higher [hazard ratio (HR) 1.3; 95% confidence interval (CI) 1.20–1.41; P < 0.001], a multivessel disease without the involvement of left main coronary artery (HR 1.72; 95% CI 1.58–1.88; P < 0.001), and with left main disease (HR 2.02; 95% CI 1.88–2.18; P < 0.001). The number of HF patients undergoing revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) increased by 7.5% (P < 0.001) per calendar year. The majority (53.4%) of HF‐CAD patients were treated medically, while a minority (46.6%) were referred for revascularization with PCI or CABG. Compared with patients treated with PCI, the proportion of patients treated medically or with CABG decreased substantially (P < 0.001). Conclusions Over 18 years, the number of patients with HF undergoing CAG has increased substantially. Expanded utilization of CAG increased the number of HF patients treated with percutaneous coronary intervention and coronary artery bypass surgery. Long‐term survival improved in all HF patients despite a steady increase of elderly patients with comorbidities.https://doi.org/10.1002/ehf2.13875Coronary angiographyCoronary artery diseaseHeart failureLong‐term survival |
| spellingShingle | Entela Bollano Björn Redfors Araz Rawshani Dimitrios Venetsanos Sebastian Völz Oskar Angerås Charlotta Ljungman Joakim Alfredsson Tomas Jernberg Truls Råmunddal Petur Petursson J. Gustav Smith Oscar Braun Henrik Hagström Ole Fröbert David Erlinge Elmir Omerovic Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease ESC Heart Failure Coronary angiography Coronary artery disease Heart failure Long‐term survival |
| title | Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
| title_full | Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
| title_fullStr | Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
| title_full_unstemmed | Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
| title_short | Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
| title_sort | temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
| topic | Coronary angiography Coronary artery disease Heart failure Long‐term survival |
| url | https://doi.org/10.1002/ehf2.13875 |
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