Coronary Artery Disease Doubles Excess Mortality in Patients With Heart Failure With Reduced Ejection Fraction

Background Assessment of coronary artery disease (CAD) in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) varies between countries and there are only limited data on the long‐term impact of CAD in these patients. We examined the association between CAD and mortality in patients with HFrEF undergoing coronary angiography. Methods and Results Using Danish registries, we identified patients with HFrEF (EF ≤40%) undergoing coronary angiography from 2003 to 2016. We estimated 10‐year cumulative incidence proportions and adjusted hazard ratios (aHR) for all‐cause death, comparing patients with HFrEF with CAD with patients with HFrEF without CAD. Both groups were further compared with an age‐ and sex‐matched general population cohort in a 1:5 ratio. We included 3294 patients with HFrEF, of whom 1436 (44%) had CAD, as well as 16 365 matched general population individuals. Median follow‐up was 5.3 years. Patients with HFrEF with CAD had higher 10‐year mortality than patients with HFrEF without CAD (55% versus 33%; aHR, 1.38 [95% CI, 1.19–1.59]). These estimates were consistent across ages, whereas greater extent of CAD was associated with higher mortality ( P trend <0.01). Compared with the matched general population, the 10‐year excess mortality was 29% for patients with HFrEF with CAD (55% versus 26%; aHR, 2.18 [95% CI, 1.92–2.48]), and 15% for patients with HFrEF without CAD (33% versus 17%; aHR, 1.87 [95% CI, 1.63–2.14]). Conclusions Presence and extent of CAD are strongly associated with all‐cause mortality in patients with HFrEF and, when compared with a matched general population, presence of CAD doubles excess mortality. This highlights the importance of CAD assessment for prognostication in patients with HFrEF.