Abstract 18184: Prognostic Value of Subjective and Objective Findings of Ischemia in Patients With Heart Failure
Introduction: Previous studies have shown that cardiac ischemia is a marker of poor prognosis in congestive heart failure. We determined the outcomes associated with subjective symptoms and objective findings of ischemia in patients presenting with acute heart failure.
Methods: We studied 10,030 participants (mean age 76±12 years, 48% male) who presented to a hospital in Ontario, Canada with a primary diagnosis of acute heart failure. Using linked administrative databases, we analyzed the long-term impact of chest pain, ST segment depression, and positive troponin on vital status, hospital readmission, diagnostic testing, and coronary revascularization.
Results: 1,724 participants presented with symptoms of chest pain, of which 348 had objective evidence of cardiac ischemia (ST segment depression or positive troponin). Of the 8,306 participants without chest pain 1,602 had objective evidence of ischemia. At baseline, the chest pain cohort had higher proportion of participants with a history of heart failure, coronary disease, revascularization, and impaired LV function. In multivariate analysis, ST segment depression and positive troponin were associated with higher cardiovascular death (HR 1.11 and 1.41, both P<0.05), revascularization events (HR 1.41 and 1.48, both P<0.01), hospitalization for myocardial infarction (HR 1.35 and 1.69, both P<0.01) and heart failure (HR 1.08 and 1.15, both P<0.05). Rates of admission for non-cardiovascular hospitalization did not differ. The presence of chest pain was associated with increased use of diagnostic testing for ischemia (HR 1.14, P<0.01) and admission for ischemic symptoms (HR 1.10, P<0.05), but lower risk of cardiovascular death (HR 0.86, P<0.01 Figure 1).
Conclusions: In this large, community-based cohort of patients presenting with acute heart failure, the presence of objective findings, but not subjective symptoms of ischemia, was associated with higher risk of major adverse cardiac outcomes.
Author Disclosures: Y. Ge: None. J.V. Tu: None. P.C. Austin: None. X. Wang: None. D.S. Lee: None.
- © 2015 by American Heart Association, Inc.