Affiliation:
1. Division of Cardiac Anesthesiology Department of Anesthesiology and Pain Medicine University of Ottawa Heart Institute Ottawa Ontario Canada
2. School of Epidemiology and Public Health University of Ottawa Ontario Canada
3. Institute for Clinical Evaluative Sciences Ontario Canada
4. Sunnybrook Schulich Heart Centre University of Toronto Ontario Canada
5. Division of Cardiology Department of Medicine University of Ottawa Heart Institute Ottawa Ontario Canada
Abstract
Background
Heart failure (
HF
) with reduced ejection fraction (
rEF
) is a widely regarded prognosticator after coronary artery bypass grafting.
HF
with preserved ejection fraction (
pEF
) accounts for up to half of all
HF
cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However,
HF
p
EF
outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of
HF
p
EF
and
HF
r
EF
in women and men following coronary artery bypass grafting.
Methods and Results
We conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data.
HF
is captured through a validated population‐based database of all Ontarians with physician‐diagnosed
HF
. We defined
pEF
as ejection fraction ≥50% and
rEF
as ejection fraction <50%. The primary outcome was all‐cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan–Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had
pEF
without
HF
, 25.7% had
rEF
without
HF
, 6.9% had
HF
p
EF
, and 12.0% had
HF
r
EF
. Age‐standardized
HF
p
EF
mortality rates at 4±2 years of follow‐up were similar in women and men.
HF
r
EF
standardized
HF
p
EF
mortality rates were higher in women than men.
Conclusions
We found a higher prevalence and poorer prognosis of
HF
p
EF
in women. A history of
HF
was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow‐up should be focused on women and men with
HF
rather than on
rEF
alone.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
44 articles.
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