title: Heart failure with preserved ejection fraction: comparison of patients with and without angina pectoris (from the Duke Databank for Cardiovascular Disease).
abstract: OBJECTIVE
  This study investigated the characteristics and outcomes of patients with heart failure with preserved ejection fraction (HFpEF) and angina pectoris (AP).
  
  
  BACKGROUND
  AP is a predictor of adverse events in patients with heart failure with reduced EF. The implications of AP in HFpEF are unknown.
  
  
  METHODS
  We analyzed HFpEF patients (EF ≥50%) who underwent coronary angiography at Duke University Medical Center from 2000 through 2010 with and without AP in the previous 6 weeks. Time to first event was examined using Kaplan-Meier methods for the primary endpoint of death/myocardial infarction (MI)/revascularization/stroke (i.e., major adverse cardiac events [MACE]) and secondary endpoints of death/MI/revascularization, death/MI/stroke, death/MI, death, and cardiovascular death/cardiovascular hospitalization.
  
  
  RESULTS
  In the Duke Databank, 3,517 patients met criteria for inclusion and 1,402 (40%) had AP. Those with AP were older with more comorbidities and prior revascularization compared with non-AP patients. AP patients more often received beta-blockers, angiotensin-converting enzyme inhibitors, nitrates, and statins (all p < 0.05). In unadjusted analysis, AP patients had increased MACE and death/MI/revascularization (both p < 0.001), lower rates of death and death/MI (both p < 0.05), and similar rates of death/MI/stroke and cardiovascular death/cardiovascular hospitalization (both p > 0.1). After multivariable adjustment, those with AP remained at increased risk for MACE (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.17 to 1.45) and death/MI/revascularization (HR: 1.29, 95% CI: 1.15 to 1.43), but they were at similar risk for other endpoints (p > 0.06).
  
  
  CONCLUSIONS
  AP in HFpEF patients with a history of coronary artery disease is common despite medical therapy and is independently associated with increased MACE due to revascularization with similar risk of death, MI, and hospitalization.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina. Electronic address: robert.mentz@duke.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Samuel
authors.initials: S
authors.lastname: Broderick
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina; Division of Clinical Pharmacology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Mona
authors.initials: M
authors.lastname: Fiuzat
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017023:Coronary Angiography; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends
keywords: AP; CI; DDCD; Duke Databank for Cardiovascular Disease; EF; HF; HFpEF; HR; IQR; KM; Kaplan-Meier; MACE; MI; NYHA; New York Heart Association; angina pectoris; confidence interval; ejection fraction; hazard ratio; heart failure; heart failure with preserved ejection fraction; interquartile range; major adverse cardiac events; myocardial infarction; outcomes