Elsevier

JACC: Heart Failure

Volume 10, Issue 11, November 2022, Pages 807-815
JACC: Heart Failure

Clinical Research
Trends in Ischemic Evaluation in New-Onset Heart Failure Without Known Coronary Artery Disease

https://doi.org/10.1016/j.jchf.2022.07.011Get rights and content
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Abstract

Background

Guidelines recommend consideration of an ischemic evaluation (Class IIa-IIb) in new-onset heart failure (HF), but it is not well-known how often this is performed and leads to revascularization.

Objectives

The authors investigated temporal trends in ischemic evaluation and revascularization within 90 days of HF onset in Denmark 2008-2018.

Methods

From the Danish nationwide administrative registries, diagnostic tests and revascularizations within 90 days were identified among patients with new-onset HF between 2008 and 2018, alive 90 days after diagnosis.

Results

Of 61,475 patients (mean age: 72.6 ± 13.8 years, 46% women), 12,503 (20%) underwent an ischemic evaluation, of whom 10,547 (84%) underwent invasive coronary angiography, and 1,956 (16%) underwent an initial noninvasive test, most frequently coronary computed tomographic angiography (n = 1,813, 93%). Of those who were initially referred for coronary computed tomographic angiography, 374 (21%) had a subsequent invasive coronary angiogram undertaken. Among individuals undergoing ischemic testing, percutaneous coronary intervention and coronary artery bypass graft surgery were performed in 1,354 (11%) and 619 (5%), respectively, corresponding to 2.2% and 1.0% of the entire sample. Between 2008 and 2018, the number of patients referred for ischemic evaluations increased, adjusted OR for 1.07 (95% CI: 1.06-1.07) per year high, and was greater among older versus younger individuals (OR: 1.01 [95% CI: 0.99-1.03], OR: 1.04 [95% CI: 1.03-1.06], OR: 1.06 [95% CI: 1.05-1.07], OR: 1.11 [95% CI: 1.09-1.12], and OR: 1.14 [95% CI: 1.10-1.18] per year increase for age group <50, 51-60, 61-75, 76-85, and >85 years, respectively, P for interaction <0.0001).

Conclusions

In clinical practice, few patients with new-onset HF are referred for an ischemic evaluation and a minority undergo revascularization. Studies are needed to establish the appropriateness of this practice.

Key Words

epidemiology
ischemic evaluation
new-onset heart failure
revascularization

Abbreviations and Acronyms

CABG
coronary artery bypass graft
CAD
coronary artery disease
CCTA
coronary computed tomography angiography
HF
heart failure
HFrEF
heart failure with reduced ejection fraction
ICD
International Classification of Diseases
OMT
optimal medical therapy
PCI
percutaneous coronary intervention

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