Treatment response in recent‐onset heart failure with reduced ejection fraction: non‐ischaemic vs. ischaemic aetiology

AIMS: In heart failure (HF) with reduced left ventricular ejection fraction (HFrEF), the prognosis appears better in non‐ischaemic than in ischaemic aetiology. Infrequent diagnostic work‐up for ischaemic heart disease (IHD) in HF is reported. In this study, we compared short‐term response to initiated guideline‐directed medical treatment (GDMT) in recent‐onset HFrEF of non‐ischaemic (non‐IHF) vs. ischaemic (IHF) aetiology and evaluated the frequency of coronary investigation. METHODS AND RESULTS: Patients hospitalized with recent‐onset HFrEF [left ventricular ejection fraction (LVEF) < 40%] between 1 January 2016 and 31 December 2019 were included. Treatment response was determined by use of a hierarchical clinical composite outcome classifying each patient as worsened, improved, or unchanged based on hard outcomes (mortality, heart transplantation, and HF hospitalization) and soft outcomes (± ≥10 unit change in LVEF, ± ≥30% change in N‐terminal pro‐B‐type natriuretic peptide, and ± ≥1 point change in New York Heart Association functional class) during 28 weeks of follow‐up. The associations between baseline characteristics and composite changes were analysed with multiple logistic regression. Among the 364 patients analysed, 47 were not investigated for IHD. Comparing non‐IHF (n = 203) vs. IHF (n = 114), patients were younger (mean age 61.0 vs. 69.4 years, P < 0.001) with lower mean LVEF (26% vs. 31%, P < 0.001), but with similar male predominance (70.4% vs. 75.4%, P = 0.363). For non‐IHF vs. IHF, the composite outcomes were worsened (19.1% vs. 43.9%, P < 0.001) and improved (74.2% vs. 43.9%, P < 0.001). After multivariable adjustments, IHF was associated with increased odds for worsening [odds ratio (OR) 2.94; 95% confidence interval (CI) 1.51–5.74; P = 0.002] and decreased odds for improvement (OR 0.35; 95% CI 0.18–0.65; P < 0.001). In cases without previous IHD or new‐onset myocardial infarction (n = 261), a decision for coronary investigation was made in 69.0%. CONCLUSIONS: In recent‐onset HFrEF, patients with non‐IHF responded better to GDMT than patients with IHF. Almost one‐third of patients selected for follow‐up at HF clinics were never investigated for IHD.