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18-07-2016 | Heart failure | News | Article

HF and ejection fraction both impact CABG outcomes

medwireNews: Both heart failure (HF) and reduced ejection fraction (rEF) influence the outcomes of patients undergoing coronary artery bypass grafting (CABG), say researchers.

Their study included 41,906 patients undergoing CABG, identified in a Swedish registry. After accounting for confounders, the 1216 patients with HF but a preserved EF (HFpEF) were a significant 1.62 times more likely than the 27,165 with no features of HF to die within 30 days after surgery and 1.83 times more likely to die during an average 6 years of long-term follow-up.

And the mortality risk was increased further if patients also had a rEF. These 3456 patients had 2.52- and 2.29-fold increased risk of death within 30 days and during long-term follow-up, respectively.

Ulrik Sartipy (Karolinska University Hospital, Stockholm, Sweden) and co-researchers highlight the adverse effect of HF even when patients have pEF. “Preoperative assessment before CABG includes echocardiography and assessment of EF”, they say. “However, HFpEF is increasingly common, and this diagnosis may be neglected.”

Their findings emphasise that HF “should be carefully considered in preoperative assessment and postoperative follow-up”, regardless of EF, the team writes in JAMA Cardiology.

However, the team also found that a rEF predicted mortality even in patients without HF, conferring 2.25- and 1.47-fold risk increases of 30-day and long-term mortality, respectively. Moreover, it was a very common condition, with 10,069 (24%) of all patients having an EF below 50%, despite no other signs of HF.

“Therefore, echocardiography adds important preoperative information”, the team observes.

The impact on mortality varied with the degree of EF reduction. Among patients without HF, having an EF below 50% but not less than 30% increased the 30-day and long-term mortality risk 1.37- and 1.75-fold, respectively, whereas having an EF below 30% was associated with 2.60- and 6.02-fold increases. There was a similar pattern in patients who also had HF.

By Eleanor McDermid

medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016