title: Influence of documented history of coronary artery disease on outcomes in patients admitted for worsening heart failure with reduced ejection fraction in the EVEREST trial.
abstract: OBJECTIVE
  Data on the prognosis of heart failure (HF) patients with coronary artery disease (CAD) have been conflicting. We describe the clinical characteristics and mode-specific outcomes of HF patients with reduced ejection fraction (EF) and documented CAD in a large randomized trial.
  
  
  RESULTS
  EVEREST was a prospective, randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with worsening HF and reduced EF. Patients were classified as having CAD based on patient-reported myocardial infarction (MI) or coronary revascularization. We analysed the characteristics and outcomes [all-cause mortality and cardiovascular (CV) mortality/HF hospitalization] of patients with and without documented CAD. All events were centrally adjudicated. Documented CAD was present in 2353 patients (57%). Patients with CAD were older and had more co-morbidities compared with those without CAD. Patients with CAD were more likely to receive a beta-blocker, but less likely to receive an angiotensin-converting enzyme (ACE) inhibitor or aldosterone antagonist (P < 0.01). After risk adjustment, patients with documented CAD had similar mortality [hazard ratio (HR) 1.12, 95% confidence interval (CI) 0.97-1.30], but were at an increased risk for CV mortality/HF hospitalization (HR 1.25, 95% CI 1.12-1.41) due to an increased risk for HF hospitalization (HR 1.26, 95% CI 1.10-1.44). Patients with CAD had increased HF- and MI-related events, but similar rates of sudden cardiac death.
  
  
  CONCLUSIONS
  Documented CAD in patients hospitalized for worsening HF with reduced EF was associated with a higher burden of co-morbidities, lower use of HF therapies (except beta-blockers), and increased HF hospitalization, while all-cause mortality was similar.
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Allen
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Kwasny
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Konstam
authors.forename: James E
authors.initials: JE
authors.lastname: Udelson
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Ambrosy
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Fought
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Robert O
authors.initials: RO
authors.lastname: Bonow
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D065092:Antidiuretic Hormone Receptor Antagonists; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000188:drug therapy*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D065092:Antidiuretic Hormone Receptor Antagonists