Background:
Heart failure (HF) patients with aortic stenosis (AS) constitute a high-risk population posing diagnostic and therapeutic challenges. Few studies have characterized the burden of AS in patients admitted with acute decompensated HF (ADHF), stratified by ejection fraction (EF).
Methods:
The Atherosclerosis Risk in Communities study conducted community-based surveillance of a random sample of ADHF hospitalizations for residents ≥55 years of age in four US communities. ADHF cases were subclassified as having reduced (HFrEF) or preserved (HFpEF) EF using a 50% cutoff. AS severity was determined from echocardiogram reports obtained during abstracted hospitalizations. Odds of moderate or severe AS in patients with varying sex and race, and odds of all-cause 1-year mortality in those with higher AS severity were estimated using multivariable logistic regression.
Results:
From 2005-2014, there were 14,289 weighted ADHF hospitalizations of whom 7,357 had HFrEF (45.0% female, 36.6% black) and 6,932 HFpEF (62.9% female, 26.5% black). The prevalence of moderate or severe AS was 5.67% in HFrEF and 9.43% in HFpEF. Patients with higher AS severity were older than those with none or mild AS in both HFrEF ([mean age] 79.7 vs. 74.4 years, p<0.0001) and HFpEF (81.7 vs. 76.3 years, p<0.0001). No difference in odds of higher AS severity was detected between females and males in both HFrEF (5.49% vs. 5.81%, OR: 1.03, 95% CI: 0.83-1.27) and HFpEF (9.10% vs. 9.99%, OR: 0.89, 95% CI: 0.75-1.06). Moderate or severe AS was more likely in whites than blacks in both HFrEF (8.32% vs. 1.67%, OR: 0.23, 95% CI: 0.17-0.32) and HFpEF (11.1% vs. 6.38%, OR: 0.70, 95% CI: 0.56-0.88). Higher AS severity was independently associated with increased all-cause 1-year mortality after ADHF hospitalization in both HFrEF (44.3% vs. 30.5%, OR: 1.25, 95% CI: 1.16-1.35) and HFpEF (33.4% vs. 26.1%, OR: 1.16, 95% CI: 1.08-1.24).
Conclusion:
In ADHF patients with HFrEF or HFpEF, whites are more affected by AS than blacks, as are older patients when compared to their younger counterparts. Higher AS severity in ADHF patients is independently associated with all-cause mortality at 1 year after hospitalization, regardless of EF.
