Affiliation:
1. Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
2. Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
3. Cardiology Division Cardiovascular Department Papa Giovanni XXIII Hospital Bergamo Italy
Abstract
Background
A thorough analysis of noncardiac determinants of mortality in heart failure (
HF
) is missing. Furthermore, evidence conflicts on the outcome of patients with
HF
and no or mild systolic dysfunction. We aimed to investigate the prevalence of noncardiac and cardiac causes of death in a cohort of chronic
HF
patients, covering the whole spectrum of systolic function.
Methods and Results
We enrolled 2791 stable
HF
patients, classified into HF with reduced ejection fraction (
HF
r
EF
; left ventricular ejection fraction [EF] <40%), HR with midrange EF (
HF
mr
EF
; left ventricular
EF
41–49%), or HF with preserved
EF
(
HF
p
EF
; left ventricular
EF
≥50%), and followed up for all‐cause, cardiac, and noncardiac mortality (adjudicated as due to cancer, sepsis, respiratory disease, renal disease, or other causes). Over follow‐up of 39 months, adjusted mortality was lower in
HF
p
EF
and
HF
mr
EF
versus
HF
r
EF
(hazard ratio: 0.75 [95%
CI,
0.67–0.84],
P
<0.001 for
HF
p
EF
; hazard ratio: 0.78 [95%
CI
, 0.63–0.96],
P
=0.017 for
HF
mr
EF
).
HF
r
EF
had the highest rates of cardiac death, whereas noncardiac mortality was similar across left ventricular
EF
categories. Noncardiac causes accounted for 62% of deaths in
HF
p
EF
, 54% in
HF
mr
EF
and 35% in
HF
r
EF
; cancer was twice as frequent as a cause of death in
HF
p
EF
and
HF
mr
EF
versus
HF
r
EF
. Yearly rates of noncardiac death exceeded those of cardiac death since the beginning of follow‐up in
HF
p
EF
and
HF
mr
EF
.
Conclusions
Noncardiac death is a major determinant of outcome in stable
HF
, exceeding cardiac‐related mortality in
HF
p
EF
and
HF
mr
HF
. Comorbidities should be regarded as main therapeutic targets and objects of dedicated quality improvement initiatives, especially in patients with no or mild systolic dysfunction.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
73 articles.
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