Prevalence and prognostic impact of coronary artery disease in heart failure with preserved ejection fraction

Coronary artery disease (CAD) is increasingly recognized as a key contributor to the pathophysiological mechanisms of heart failure with preserved ejection fraction (HFpEF). However, the prevalence and impact of CAD in this population remain inadequately characterized.

To determine the prevalence of CAD among hospitalized patients with HFpEF and its association with clinical outcomes.

We conducted a prospective multicenter registry of acute decompensated HFpEF (PURSUIT HFpEF registry: n = 1,238 enrolled between June 2016 and February 2022 from 32 institutions in Japan). Participants were classified into two groups based on the presence or absence of CAD. Kaplan-Meier survival analysis and Cox proportional hazards modeling were used to evaluate the associations between CAD and the primary endpoint, all-cause death.

We analyzed data from eligible 1,223 patients ( 81±9 years, 55％ female) with CAD information available. The median of follow-up period was 1,108 days [IQR: 673-1,596 days]. The prevalence of CAD was 17% [CAD(+) group, n=213 vs. CAD(-) group, n=1,010]. In the Kaplan-Meier analysis, the CAD(+) group demonstrated a significantly higher 3-year Kaplan-Meier estimated rate of the primary endpoint compared to the CAD(-) group (35% vs. 31%, Log-rank test p = 0.003). Multivariate Cox regression analysis identified CAD (adjusted HR: 1.34, 95% CI: 1.015–1.765, p = 0.039) as an independent predictor of all-cause death.

In the Japanese HFpEF population, the prevalence of CAD was 17%. CAD was associated with significantly worse clinical outcomes in patients with acute decompensated HFpEF. These findings highlight the importance of recognizing CAD as a prognostic marker in this population and underscore the need for targeted management strategies.