Ischemic Evaluation and Long-Term Mortality in New-Onset Heart Failure Across Various Age-Groups

BACKGROUND AND OBJECTIVES: The prognostic significance of ischemic evaluation in patients with new-onset heart failure is not well understood and may differ according to age and sex. In a real-world cohort, we analyzed the long-term mortality risk after undergoing an ischemic evaluation.

METHODS: All new-diagnosed heart failure patients 2008-2018 without prior ischemic evaluation, known coronary artery disease, or acute myocardial infarction were identified from the Danish National patient registry. The association of an ischemic evaluation within 90 days of heart failure diagnosis with long-term mortality was analyzed by inverse probability weighted Cox regression models.

RESULTS: A total of 61,475 patients were included (mean age 73.3±13.9 years, 46% women), of which 12,503 (20%) underwent an ischemic evaluation. During a mean follow-up of 4.6 years, 37% of patients died, corresponding to a mortality rate of 8.0 (7.9-8.1) per 100 person-years. The multivariable-adjusted hazard ratio of death was 0.92 (95% confidence interval, 0.90-0.95) for patients who underwent ischemic evaluation, compared with patients who did not. An ischemic evaluation was associated with a lower hazard ratio in males than females: 0.87 (0.84-0.90) vs. 0.98 (0.94-1.02), and in middle-aged vs. older or younger individuals: 0.91 (0.75-1.12) in patients ≤50 years, 0.82 (0.72-0.93) in 51-60 years, 0.83 (0.79-0.87) in 61-75 years, 0.93 (0.88-0.97) in >75-85 years, and 1.02 (0.97-1.07) in >85 years, respectively.

CONCLUSIONS: Obtaining an ischemic evaluation was associated with marginal to no improvement in long-term mortality for many new-diagnosed heart failure patients, including the very elderly.