Coronary Artery Disease Is A Stronger Predictor of All‐Cause Mortality Than Left Ventricular Ejection Fraction Among Patients With Newly Diagnosed Heart Failure: Insights From the WDHR

Abstract

Background In patients with newly diagnosed heart failure (HF) and left ventricular ejection fraction (LVEF) <50%, little is known whether LVEF per se or presence of coronary artery disease (CAD) provides independent prognostic information on all‐cause mortality. Methods and Results Using the WDHR (Western Denmark Heart Registry), we identified 3620 patients with newly diagnosed HF and LVEF 10% to 49% referred for first‐time coronary angiography as part of general workup of HF. Patients were stratified by LVEF (10%–35% versus 36%–49%) and presence of CAD. We estimated 10‐year all‐cause mortality risk and calculated hazard ratios adjusted for relevant comorbidities and risk factors (aHRs). CAD was present in 1592 (44%) patients. Lower LVEF was associated with a relative 15% increased 10‐year mortality: 37% for LVEF 36% to 49% versus 42% for LVEF 10% to 35% (aHR, 1.15 [95% CI, 0.99–1.34]). This result did not change when stratified into those with CAD (52% versus 56%; aHR, 1.11 [95% CI, 0.91–1.35]) and those without CAD (27% versus 33%; aHR, 1.24 [95% CI, 0.97–1.57]). In comparison, presence and extent of CAD were associated with a relative 43% increased 10‐year mortality (CAD versus no CAD, 55.0% versus 31.5%; aHR, 1.43 [95% CI, 1.25–1.64]). Compared with a matched general population, excess mortality risk was higher for patients with HF and CAD (54.7% versus 26.3%; aHR, 2.10 [95% CI, 1.85–2.39]) versus those with HF and no CAD (31.4% versus 17.2%; aHR, 1.76 [95% CI, 1.52–2.02]). Conclusions Among newly diagnosed patients with HF and LVEF <50%, presence and extent of CAD are associated with substantial higher all‐cause mortality risk than lower LVEF.