Heart failure etiology impacts survival of patients with heart failure

Abstract

Background: The impact of heart failure (HF) etiology on prognosis of HF is not well known.

Methods: 3078 patients (median age 75 years, 61% male) hospitalized with HF were studied. Patients were classified into six etiology groups: hypertension (HTN, 13.9%), ischemic heart disease (IHD, 42.4%), valvular disease (VHD, 9.5%), dilated cardiomyopathy (DCM, 7.9%), other (11.5%), and unknown etiology (14.8%). Patients with normal left ventricular ejection fraction (LVEF) were also included. Follow-up was up to 5 years.

Results: In multivariable analysis, with HTN as the reference, VHD showed the highest risk, HR 1.71 (CI: 1.3-2.2, p<0.0001), followed by DCM, HR 1.66 (CI: 1.2-2.3, p=0.002), IHD, HR 1.4 (CI: 1.1-1.7, p=0.001), and unknown etiology, HR 1.4 (CI: 1.1-1.7, p=0.007). For HF of IHD mortality risk was greater for patients with LVEF<30% (HR 2.1, CI: 1.7-2.7, p<0.0001) than for patients with LVEF ≥ 30% (HR 1.3, CI: 1.0-1.5, p=0.03), compared to the reference (p-value for interaction<0.001).

Conclusion: HF due to VHD, DCM and IHD carry a worse prognosis than that of HTN. For the IHD the risk increases progressively with lower values of LVEF.