Impact of CAD in Women With Newly Diagnosed HFrEF

Quick Takes

  • The prognosis of women with CAD and HF continues to differ from men with similar disease.
  • Mortality is affected in women with CAD and HFrEF and CAD.
  • Women continue to be under-represented in clinical trials focusing on HFrEF.

Study Questions:

What is the prognostic value of women who have new heart failure with reduced ejection fraction (HFrEF) and coronary artery disease (CAD)?


This is an observational cohort study based on the Western Denmark Heart Registry in Western Denmark. HFrEF was defined as patients with a left ventricular ejection fraction (LVEF) ≤40%, who were referred for first-time elective coronary angiography (CAG) with the referral diagnosis being HF between January 1, 2003 to December 31, 2016. Patients were excluded if they: were <18 years old; underwent nonelective procedures; had any other indication for CAG than cardiomyopathy; had LVEF <10%; had a history of myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting; or if the patient died or emigrated within the first 30 days after the index CAG. Presence of CAD was defined as obstructive CAD (≤50% stenosis in ≥1 coronary vessel) or diffuse CAD (1-49% stenosis in >1 coronary vessel). Absence of CAD was defined as no CAD in all coronary vessels or mild nonobstructive CAD in a single vessel by CAG. All-cause death was assessed.


Out of 54,186 patients, 3,294 had newly diagnosed HF with LVEF 10-40% and underwent CAG as part of their workup of HF. Of these, 27% were female. Women were younger than men at time of CAG but both groups had a median LVEF of 30%. Approximately 31% of females had CAD by CAG but men tended to have multivessel CAD. The 10-year cumulative incidence of all-cause mortality was 41.8% (95% confidence interval [CI], 39.5-44.3) in the entire HFrEF cohort.

Females had a 15% relatively lower 10-year mortality than men (37% vs. 44%; adjusted hazard ratio [aHR], 0.85; 95% CI, 0.73-0.99). Patients with HFrEF and three-vessel disease had the highest 10-year mortality: 59% for women (95% CI, 40%-78%) and 69% (95% CI, 62%-78%) for men. Finally, there was no difference between men and women in 10-year mortality among patients with CAD treated with revascularization within 6 months following the index CAG (aHR, 1.03; 95% CI, 0.70-1.52).


In patients with HFrEF, the presence of CAD has a significantly greater impact on mortality among women than among men.


Women continue to be under-represented in clinical trials for HFrEF. The present study assessed mortality differences between women and men with newly diagnosed HFrEF referred for evaluation of CAD. The presence of CAD has a greater prognostic impact in women compared to men with newly diagnosed HFrEF.

Clinical Topics: Heart Failure and Cardiomyopathies, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure

Keywords: Coronary Artery Disease, Heart Failure

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