Heart failure re-hospitalizations and subsequent fatal events in coronary artery disease: insights from COMMANDER-HF, EPHESUS, and EXAMINE

Ferreira, J. P. et al. (2021) Heart failure re-hospitalizations and subsequent fatal events in coronary artery disease: insights from COMMANDER-HF, EPHESUS, and EXAMINE. Clinical Research in Cardiology, 110(10), pp. 1554-1563. (doi: 10.1007/s00392-021-01830-1) (PMID:33686472)

Abstract

Background: Patients with coronary artery disease (CAD) are at increased risk of developing and being hospitalised for heart failure (HFH). However, the risk of HFH versus ischemic events may vary among patients with CAD, depending on whether acute myocardial infarction (MI), left ventricular dysfunction or decompensated HF is present at baseline. Aims: We aim to explore the risk of non-fatal events (HFH, MI, stroke) and subsequent death in 3 landmark trials, COMMANDER-HF, EPHESUS and EXAMINE that, together, included patients with CAD with and without reduced ejection fraction and acute MI. Methods: Events, person-time metrics and time-updated Cox models. Results: In COMMANDER-HF the event-rate for the composite of AMI, stroke or all-cause death was 13.5 (12.8–14.3) events/100 py. Rates for AMI and stroke were much lower (2.2 [2.0–2.6] and 1.3 [1.1–1.6] events/100 py, respectively) than the rate of HFH (16.9 [16.1–17.9] events/100 py). In EPHESUS, the rates of MI and stroke were also lower than the rate of HFH: 7.2 (6.7–7.8), 1.9 (1.7–2.3), and 10.6 (9.9–11.3) events/100 py, but this was not true for EXAMINE with 4.4 (4.0–4.9), 0.7 (0.6–0.9), and 2.4 (2.0–2.7) events/100 py, respectively. In all 3 trials, a non-fatal event (HFH, MI or stroke) during follow-up doubled the risk of subsequent mortality. This most commonly followed a HFH. Conclusions: A first or recurrent HFH is common in patients with CAD and AMI or HFrEF and indicates a poor prognosis. Preventing the development of heart failure after AMI and control of congestion in patients with CAD and HFrEF are key unmet needs and therapeutic targets. Registration: ClinicalTrials.gov Identifier: NCT01877915. URL: https://clinicaltrials.gov/ct2/show/NCT01877915.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Ferreira, J. P., Cleland, J. G., Lam, C. S.P., Anker, S. D., Mehra, M. R., van Veldhuisen, D. J., Byra, W. M., La Police, D. A., Pitt, B., Greenberg, B., and Zannad, F.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Clinical Research in Cardiology
• Publisher: Springer
• ISSN: 1861-0684
• ISSN (Online): 1861-0692
• Published Online: 08 March 2021
• Copyright Holders: Copyright © 2021 Springer-Verlag GmbH, DE part of Springer Nature
• First Published: First published in Clinical Research in Cardiology 110(10): 1554-1563
• Publisher Policy: Reproduced in accordance with the publisher copyright policy