FEV1 is a major prognostic factor in diverse Heart Failure populations: findings from a Global Heart Failure registry

AIMS: Pulmonary abnormalities are commonly reported in heart failure (HF) and may have prognostic implication. Current evidence is limited to high-income countries. We examined the relationship between forced expiratory volume in 1 second (FEV1), HF burden and long-term clinical outcomes in a diverse multi-national HF cohort. METHODS AND RESULTS: In a sub-study within the multinational Global Congestive Heart Failure registry, which collected clinical data including spirometry from HF participants in 28 high-, middle- and low-income countries; and followed for a median 3.8 (IQR 2.1, 5.0) years. Baseline FEV1 was transformed into z-scores standardised for age, sex, and height. The association between baseline FEV1 with all-cause mortality, cardiovascular (CV) deaths and all-cause hospitalisations were examined. FINDINGS: The analysis included 3,359 HF participants (mean age 61.9 SD 14.1 years, 66.4% males). Participants with lower FEV1 z-scores even within the normal range (z-score >-2), showed increasing burden of HF, cardiac structural and functional impairment, and lower health-related quality of life. FEV1 z-score ≤-2 was independently associated with higher risks of all-cause (HR 2.20 95%CI 1.61-3.01), CV mortality (HR 2.45 1.64-3.66) and hospitalisations (HR 1.40 1.12-1.74). The effect sizes were comparable to other major prognostic factors. The association was consistent across populations from diverse socio-economic development, HF aetiology, HF types and airflow obstruction. CONCLUSION: In a diverse, multi-national HF cohort, reductions in FEV1 were independently associated with higher HF burden and poor health outcomes. The effect of lower FEV1 was generalisable across the HF spectrum, and comparable to other major established HF prognostic factors.