Heart failure with preserved left ventricular systolic function among patients with non-ST-segment elevation acute coronary syndromes.
Previous studies of non-ST-segment elevation acute coronary syndromes (NSTE ACSs) complicated by heart failure (HF) have focused primarily on patients with left ventricular systolic dysfunction defined by an ejection fraction (EF) <40%. Little is known about HF with preserved systolic function (EF > or =40%) in the NSTE ACS population. We identified high-risk patients with NSTE ACS (ischemic electrocardiographic changes and/or positive cardiac markers) from the CRUSADE quality improvement initiative who had an EF recorded and who had information on HF status. Management and outcomes were analyzed and compared based on the presence or absence of HF and whether left ventricular EF was > or =40%. Of 94,558 patients with NSTE ACS, 21,561 (22.8%) presented with signs of HF, and most had HF with preserved systolic function (n = 11,860, 55%). Mortality rates were 10.7% for HF/systolic dysfunction, 5.8% for HF/preserved systolic function, 5.7% for no HF/systolic dysfunction, and 1.5% for no HF/preserved systolic function. Use of guideline-recommended medical therapies and interventions was frequently significantly lower in those with HF regardless of EF compared with those without HF, except for use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. In conclusion, NSTE ACS complicated by HF with preserved systolic function is common and associated with a 2.3-fold higher mortality compared with NSTE ACS without HF or systolic dysfunction. Guideline-recommended therapies and interventions are under-utilized in patients with NSTE ACS and HF, with and without preserved systolic function, compared with those without HF.
Bennett
Kyla M
KM
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Hernandez
Adrian F
AF
Chen
Anita Y
AY
Mulgund
Jyotsna
J
Newby
L Kristin
LK
Rumsfeld
John S
JS
Hochman
Judith S
JS
Hoekstra
James W
JW
Ohman
E Magnus
EM
Gibler
W Brian
WB
Roe
Matthew T
MT
Peterson
Eric D
ED
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012107:Research Design; D012720:Severity of Illness Index; D013318:Stroke Volume; D016019:Survival Analysis; D013577:Syndrome; D013599:Systole; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left
D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T; D052279:Creatine Kinase, MB Form