Physicians' Academy for Cardiovascular Education

HFmrEF resembles HFrEF rather than HFpEF regarding IHD

Significance of Ischemic Heart Disease in Patients With Heart Failure and Preserved, Midrange, and Reduced Ejection Fraction: A Nationwide Cohort Study

Literature - Vedin O, Lam CSP, Koh AS, et al. - Circ Heart Fail. 2017;10:e003875.


In recent international heart failure (HF) guidelines, patients with an ejection fraction (EF) of 40% to 49% were characterized as having HF with midrange EF (HFmrEF) [1,2]. Ischemic heart disease (IHD) is associated with an increased risk of HF. Although there is evidence pointing to an increased favor of HFmrEF and HF with preserved EF (HFpEF) post-IHD events compared to HF with reduced EF (HFrEF), there are crucial gaps in evidence, including the understanding of how different HF types affect ischemic outcomes and the uncertainty about the role of established IHD in determining the risk of new ischemic events or other outcomes and the role of established IHD in longitudinal changes in EF in HFmrEF and HFpEF and HFrEF [3-5].

In the Swedish Heart Failure Registry, any patient with HF was registered according to clinical judgement. In this analysis, associations between prevalent IHD and risk of new ischemic and other events in patients with different types of HF were evaluated as well as between concurrent prevalent and incident IHD and longitudinal EF changes across the different HF types. For this, 42 987 patients were evaluated during a median follow-up of 2.2 years. The primary outcome was time to a fatal or non-fatal IHD event and the secondary outcomes were time to fatal or non-fatal HF event, fatal or non-fatal cardiovascular (CV) event and all-cause mortality.

Main results


In the Swedish Heart Failure Registry, HFmrEF resembled HFrEF rather than HFpEF, with respect to IHD as underlying cause and HFmrEF and HFrEF had an elevated risk of ischemic events compared with HFpEF. Established IHD had an adverse impact on most of study outcomes in all HF categories, although most prominent for new IHD events and in HFrEF. These findings are of importance to future research strategies on prevention and treatment of different HF types and IHD.


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