A high HFpEF-ABA score (≥50%) was significantly associated with an increased risk of all-cause death and unplanned hospitalization for worsening HF in CAD patients (HR 1.46; 95% CI 1.09-1.96; P=0.011).
Cohort (n=3,307)
Yes
Does a high HFpEF-ABA score predict all-cause death and unplanned hospitalization for worsening HF in patients with CAD and LVEF ≥50% without known HF?
The HFpEF-ABA score effectively identifies CAD patients with preserved LVEF at high risk for mortality and heart failure hospitalization.
Effect estimate: HR 1.46 (95% CI 1.09-1.96)
p-value: p=0.011
Abstract Background Coronary artery disease (CAD) is a significant risk factor for heart failure (HF) with preserved ejection fraction (HFpEF) and is associated with increased mortality. However, an optimal diagnostic method to identify such patients remains undefined. The HFpEF-ABA score was recently introduced as a tool to assess the pretest probability of HFpEF and was shown to predict adverse HF events. Purpose This study aimed to evaluate the utility of the HFpEF-ABA score for risk stratification in patients with CAD. Methods This retrospective multicenter cohort study analyzed data of the patients who underwent percutaneous coronary intervention for acute or chronic coronary syndrome between April 2013 and March 2019, using the Clinical Deep Data Accumulation System (CLIDAS) database. Patients with a left ventricular (LV) ejection fraction of ≥50% and no known history of HF were included. The pretest probability of HFpEF was calculated using the validated HFpEF-ABA score, which is based on age, body mass index, and a history of atrial fibrillation, as previously reported. Patients were stratified into patients with high (≥50%) and low (50%) HFpEF-ABA score, and followed-up for a maximum of 6 years. The primary endpoint was a composite of all-cause death and unplanned hospitalization for worsening HF. The secondary endpoints were each individual endpoint. Results In total, 3307 patients were included in the analysis (median age, 71 years; 75% male). Patients with a high HFpEF-ABA score had significantly higher rates of anemia, renal dysfunction, and hypertension, as well as significantly larger left atrial dimensions, higher LV mass index, and elevated brain natriuretic peptide levels, reflecting an HFpEF phenotype. During a median follow-up of 721 days, 275 patients experienced the primary endpoint. After adjusting for multiple variables using Cox multivariate analysis, the HFpEF-ABA score remained significantly associated with the primary endpoint, regardless of whether it was treated as a continuous or categorical (≥50% vs 50%) variable (hazard ratio: 1.01 95% confidence interval: 1.00–1.02, P=0.016, and 1.46 1.09–1.96, P=0.011, respectively). Patients with a high HFpEF-ABA score had a significantly higher risk of the primary endpoint (Figure). Furthermore, even when analyzed separately, a high score was significantly associated with all-cause mortality (P=0.005, log-rank test) and unplanned hospitalization for HF (P=0.006, Gray’s test). Conclusion The HFpEF-ABA score effectively identifies a subset of CAD patients with a distinct HFpEF phenotype. Furthermore, a high HFpEF-ABA score is associated with a poor prognosis, even among patients with CAD.Figure
Nishikawa et al. (Sat,) conducted a cohort in Coronary artery disease (n=3,307). High HFpEF-ABA score (≥50%) vs. Low HFpEF-ABA score (<50%) was evaluated on Composite of all-cause death and unplanned hospitalization for worsening HF (HR 1.46, 95% CI 1.09-1.96, p=0.011). A high HFpEF-ABA score (≥50%) was significantly associated with an increased risk of all-cause death and unplanned hospitalization for worsening HF in CAD patients (HR 1.46; 95% CI 1.09-1.96; P=0.011).