title: Comparison of outcomes after hospitalization for worsening heart failure, myocardial infarction, and stroke in patients with heart failure and reduced and preserved ejection fraction.
abstract: OBJECTIVE
  To investigate the prognostic significance of hospitalization for worsening heart failure (WHF), myocardial infarction (MI), and stroke in patients with chronic heart failure (HF).
  
  
  RESULTS
  We studied 5011 patients with HF and reduced EF (HF-REF) in the CORONA trial and 4128 patients with HF and preserved EF (HF-PEF) in the I-Preserve trial. Adjusted hazard ratios (HRs) for death were estimated for 0-30 days and ≥31 days after first post-randomization WHF, MI, or stroke used as a time-dependent variable, compared with patients with none of these events. In CORONA, 1616 patients (32%) had post-randomization first events (1223 WHF, 216 MI, 177 stroke), and the adjusted HR for mortality ≤30 days after an event was: WHF 7.21 [95% confidence interval (CI) 2.05-25.40], MI 23.08 (95% CI 6.44-82.71), and stroke 32.15 (95% CI 8.93-115.83). The HR for mortality at >30 days was: WHF 3.62 (95% CI 3.11-4.21), MI 4.41 (95% CI 3.23-6.02), and stroke 3.19 (95% CI 2.21-4.61). In I-Preserve, 896 patients (22%) experienced a post-randomization event (638 WHF, 111 MI, 147 stroke). The HR for mortality ≤30 days was WHF 31.77 (95% CI 7.60-132.81), MI 154.77 (95% CI 34.21-700.17), and stroke 223.30 (95% CI 51.42-969.78); for >30 days it was WHF 3.36 (95% CI 2.79-4.05), MI 3.29 (95% CI 2.14-5.06), and stroke 5.13 (95% CI 3.61-7.29).
  
  
  CONCLUSIONS
  In patients with both HF-REF and HF-PEF, hospitalization for WHF was associated with high early and late mortality. The early relative risk of death was not as great as following MI or stroke, but the longer term relative risk of death was similar following all three types of event. Numerically, more deaths occurred following WHF because it was a much more common event.
authors.affiliation: BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK; Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Søren L
authors.initials: SL
authors.lastname: Kristensen
authors.forename: Pardeep S
authors.initials: PS
authors.lastname: Jhund
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: David
authors.initials: D
authors.lastname: Preiss
authors.forename: John
authors.initials: J
authors.lastname: Kjekshus
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.forename: John
authors.initials: J
authors.lastname: Wikstrand
authors.forename: Hans
authors.initials: H
authors.lastname: Wedel
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Peter E
authors.initials: PE
authors.lastname: Carson
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D063868:Patient Outcome Assessment; D020521:Stroke / Q000175:diagnosis*; D013318:Stroke Volume / Q000502:physiology*
keywords: Clinical trials; HF‐PEF; HF‐REF; Heart failure; Mortality