FEV₁ is a major prognostic factor in diverse heart failure populations: findings from the Global Heart Failure registry

Pulmonary abnormalities are commonly reported in heart failure (HF) and may have prognostic implications. Current evidence is limited to high-income countries. We examined the relationship between forced expiratory volume in 1 second (FEV₁), HF burden, and long-term clinical outcomes in a diverse multi-national HF cohort.

In a sub-study within the multinational Global Congestive Heart Failure registry, which collected clinical data including spirometry from HF participants in 28 high-, middle-, and low-income countries, and followed for a median 3.8 (IQR 2.1, 5.0) years. Baseline FEV₁ was transformed into z-scores standardized for age, sex, and height. The association between baseline FEV₁ with all-cause mortality, cardiovascular (CV) deaths, and all-cause hospitalizations was examined.

The analysis included 3359 HF participants (mean age 61.9 [SD 14.1] years, 66.4% males). Participants with lower FEV₁ z-scores, even within the normal range (z-score>−2), showed increasing burden of HF, cardiac structural and functional impairment, and lower health-related quality of life. FEV₁ z-score ≤ −2 was independently associated with higher risks of all-cause (HR 2.20 [95%CI 1.61–3.01]), CV mortality (HR 2.45 [1.64–3.66]), and hospitalizations (HR 1.40 [1.12–1.74]). The effect sizes were comparable to those of other major prognostic factors. The association was consistent across populations from diverse socio-economic development, HF aetiology, HF types, and airflow obstruction.

In a diverse, multi-national HF cohort, reductions in FEV₁ were independently associated with higher HF burden and poor health outcomes. The effect of lower FEV₁ was generalizable across the HF spectrum and comparable to other major established HF prognostic factors.