Abstract
Simple SummaryGiven the high morbidity and mortality linked with heart failure and the need for disease-specific treatment, there is international agreement that there is a significant need for well-planned, large-scale databases showing the true course of heart failure. We present a study based on data from the European Society of Cardiology Heart Failure registries designed to evaluate the prevalence, clinical characteristics, management and outcomes of patients with two main etiologies of heart failure: reduced left ventricular ejection fraction-ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NIDCM). Our findings show that the patients with ICM were older and had more comorbidities. In contrast, the patients with NIDCM had worse systolic heart function. Apart from the more frequent use of aldosterone antagonists in the NIDCM group, there were no other differences as regards the use of heart failure guideline-recommended medications, implantable cardioverter defibrillators or cardiac resynchronization therapy. One-year prognosis was worse in the ICM patients than in the NIDCM patients. Moreover, ICM etiology itself was associated with a worse one-year outcome.Personalized management involving heart failure (HF) etiology is crucial for better prognoses for HF patients. This study aimed to compare patients with ischemic cardiomyopathy (ICM) and patients with non-ischemic dilated cardiomyopathy (NIDCM) in terms of baseline characteristics and prognosis. We assessed 895 patients with HF with reduced left ventricular ejection fraction participating in the Polish part of the European Society of Cardiology (ESC)-HF registries. ICM was present in 583 patients (65%), NIDCM in 312 patients (35%). The ICM patients were older (p < 0.001) and had more comorbidities. The NIDCM patients more frequently had atrial fibrillation (p = 0.04) and lower LVEF (p = 0.01); therefore, they were treated more often with anticoagulants (p = 0.01) and digitalis (p < 0.001). The NIDCM patients were prescribed aldosterone antagonists more often (p = 0.01). There were no other differences as regards the use of HF guideline-recommended medications, implantable cardioverter defibrillators or cardiac resynchronization therapy. The ICM patients were more likely to be treated with statins (p < 0.001) and antiplatelet agents (p < 0.001). All-cause death, as well as all-cause death and readmissions for HF at 12 months, occurred more often in the ICM group compared with the NIDCM group (15.9% vs. 10%, p = 0.016; and 40.9% vs. 28.6%, p = 0.00089, respectively). ICM etiology was an independent predictor of the composite endpoint in the total cohort (p = 0.003). The ICM patients were older and had more comorbidities, whereas the NIDCM patients had lower LVEF. One-year prognosis was worse in the ICM patients than in the NIDCM patients. ICM etiology was independently associated with a worse one-year outcome.
Highlights
Heart failure (HF) incidence and morbidity are on the increase, with a HF prevalence of approximately 1–2% in adults in developed countries, rising to ≥10% in patients aged 70 years or over [1,2]
In this study we evaluate the prevalence of ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NIDCM) etiology as well as the associated clinical characteristics and the prognosis in HF with reduced ejection fraction (HFrEF) patients
The ICM etiology was observed in the majority of patients, which is in line with the available data showing ICM as the most common primary etiology of HFrEF, being responsible for 40–70% of cases [1,6]
Summary
Heart failure (HF) incidence and morbidity are on the increase, with a HF prevalence of approximately 1–2% in adults in developed countries, rising to ≥10% in patients aged 70 years or over [1,2]. It is estimated that of those approximately 50% suffer from HF with reduced ejection fraction (HFrEF). There are well-established therapies for HFrEF that help to improve symptoms, quality of life and outcomes, the overall prognosis in HF patients remains poor as the 5-year mortality rate after diagnosis is approximately 50% [1,3,4]. It is estimated that around 40% of patients hospitalized for HF will die or will be rehospitalized within a year, with the highest frequency of hospital readmissions in the early post-discharge period [4,5]. The current focus of HF therapy is shifting towards a better assessment of the underlying HF etiology and personalized patient management. Knowledge about clinical differences and their impact on the prognosis in ischemic cardiomyopathy (ICM) versus non-ischemic dilated cardiomyopathy (NIDCM) patients remains unsatisfactory
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