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Trends in incidence and survival in patients with heart failure in sweden: insights from swedish coronary angiography and angioplasty registry

Session Poster Session 1

Speaker Elmir Omerovic

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : E Omerovic (Gothenburg,SE)

Authors:
E Omerovic1 , 1Sahlgrenska University Hospital - Gothenburg - Sweden ,

Citation:

Background: Aging of the population and prolongation of the lives of cardiac patients by modern therapeutic innovations has led to an increasing prevalence of heart failure (HF). Despite improvements in therapy, the mortality rate in patients with HF has remained high. We aimed to evaluate the incidence and survival in patients who underwent coronary angiography with HF diagnosis in Sweden during the last two decades.

Methods: We used data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR), which contains information about all coronary angiographies and PCI (percutaneous coronary interventions) performed in Sweden (31 hospitals). We included all coronary angiographies performed in patients with HF diagnosis from 2000 to 2018 in Sweden. We used multivariate Cox proportional-hazards regression to adjust for differences in patient characteristics. Multilevel modeling was used to adjust for clustering of observations in a hierarchical database.

Results: In total, 24,171 patients were included in the study. Of these, 17,677 (73.2%) were men and 6,484 (26.8%) were women. Median follow-up time was 4,510 days (range 0-6648). Mean age was 63.7±11.3, and 32.7% were <60 years old. The number of diagnostic angiographies for HF indication increased by 5.5% per year. Normal coronary angiogram was reported in 63.2% while 36.8% had >50% diameter stenosis in one or more coronary arteries. In patients with significant coronary artery disease (CAD), 37.3% had single vessel disease (SVD), 23.8% had a multivessel disease without the involvement of left main (MVD), and 38.5% had a multivessel disease with involvement of left main (MVD-LM). The majority (53.4%) of HF patients with CAD were treated conservatively while (46.6%) were referred for revascularization with PCI or CABG. In revascularized patients (n=4,589), PCI was performed in 71.1% and 28.9% were referred for CABG. Between 2000 to 2018, age and gender adjusted survival in HF improved by 1.3% per the calendar year both in patients with and without CAD. The number of revascularized patients increased by 7.5% per the calendar year. Compared to HF patients without CAD, adjusted long-term mortality was higher in HF patients with SVD (HR 1.3; 95% CI 1.20-1.41; P<0.001), MVD (HR 1.72; 95% CI 1.58-1.88; P<0.001) and MVD-LM (HR 2.02; 95% CI 1.88-2.18; P<0.001).

Conclusions: The number of patients with HF undergoing coronary angiography and revascularization in Sweden has increased considerably over the last two decades. Long-term survival was substantially improved in HF patients with and without CAD. However, survival is better in HF patients without CAD.

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