Abstract 13328: Coronary Artery Disease is Associated with a Poor Post-Discharge Prognosis in Patients Hospitalized for Heart Failure with Reduced Ejection Fraction: Findings from the EVEREST Trial
Background: An estimated 60% of patients hospitalized for heart failure (HF) have a history of coronary artery disease (CAD).
Hypothesis: Patients admitted for worsening HF and reduced EF with a documented history of CAD are at higher risk for post-discharge morbidity and mortality than those without CAD.
Methods: We performed a post-hoc analysis of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial which randomized 4133 patients hospitalized for worsening HF and EF <40% within 48 hours of admission to placebo or tolvaptan. Patients were well-treated with evidence-based therapies. The median follow-up was 9.9 months and co-primary endpoints were all-cause mortality (ACM) and a composite of cardiovascular mortality (CVM) or HF rehospitalization. Documented CAD was defined as previous myocardial infarction (MI), coronary artery bypass graft surgery (CABG), and/or percutaneous coronary intervention (PCI). Times to ACM and CVM or HF rehospitalization were compared using Cox regression models adjusted for confounders.
Results: CAD was documented in 2353 patients (57%). Patients with and without CAD differed in terms of age, gender, medical comorbidities, and baseline medication profile (Table). Patients with CAD had higher rates of ACM and CVM or HF hospitalization. After adjusting for covariates, CAD was a significant predictor of CVM or HF hospitalization (HR=1.20, 95% CI 1.08-1.34) but not ACM (HR = 1.01, 95% CI 0.88-1.15).
Conclusion: CAD, as defined in this analysis, is an independent clinical predictor of CVM or HF rehospitalization in patients hospitalized for HF with reduced EF. Optimal management of CAD may reduce post-discharge events in this traditionally high-risk population.
- © 2011 by American Heart Association, Inc.