Copyright © 2001 by the European Society of Cardiology.
Coronary artery disease as the cause of incident heart failure in the population
a Cardiac Medicine, Imperial College School of Medicine, National Heart and Lung Institute, London, U.K.
b Clinical Cardiology, Imperial College School of Medicine, National Heart and Lung Institute, Charing Cross Hospital, London, U.K.
c Cardiac Imaging, Imperial College School of Medicine, National Heart and Lung Institute, London, U.K.
d Department of Medical Statistics and Evaluation, Imperial College School of Medicine, Hammersmith Hospital, London, U.K.
Received March 27, 2000; accepted May 17, 2000
Abstract
Aims New approaches in the treatment of ischaemic left ventricular dysfunction, including revascularization, make it increasingly important to identify heart failure cases resulting from coronary artery disease. Without angiography these cases may be missed. We investigated the frequency of coronary artery disease in incident cases of heart failure in the population.
Methods and Results We identified all incident cases of heart failure in a population of 292000 in South London, U.K. by monitoring patients admitted to hospital and through a rapid access heart failure clinic. The presence and severity of coronary artery disease was identified by coronary angiography in patients under 75 years. Myocardial perfusion scanning was used to elucidate the aetiological significance of the coronary artery disease and identify hibernating myocardium. Three hundred and thirty-two cases of new heart failure were identified over 15 months. One hundred and thirty-six cases were under 75 years and angiography was undertaken in 99/136 (73%). Coronary artery disease was the aetiology in 71/136 (52%). In 18 of these 71 cases (25%), the aetiology was not recognised to be due to coronary artery disease prior to angiography, including eight cases with hibernating myocardium.
Conclusion Coronary artery disease is the cause of 52% (95% CI 43–61%) of incident heart failure in the general population under 75 years. Clinical assessment without angiography under-estimates the proportion of patients with coronary artery disease, and fails to identify those patients who may benefit from revascularization.
Key Words: Heart failure, coronary disease, epidemiology, hibernation
f1 Correspondence: Dr Kevin Fox, Cardiac Medicine (Clinical Epidemiology), Imperial College School of Medicine, National Heart and Lung Institute, 3rd Floor Britten Wing, Dovehouse Street, London SW3 6LY, U.K.
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