Ischemic risk in patients with heart failure with preserved ejection fraction: A post hoc analysis of the TOPCAT data

Heart failure with preserved ejection fraction (HFpEF) patients have a high burden of comorbidities that could predispose them to ischemic vascular event. The profile of ischemic risk among HFpEF patients is not fully understood. We aim to evaluate the risk, risk factors, and prognostic significance of ischemic events among HFpEF patients.A total of 1767 HFpEF patients from Americas in the TOPCAT trial were included in our analysis. Ischemic event was defined as myocardial infarction or ischemic stroke during follow-up. Multivariate competing risks regression model was used to identify risk factors of ischemic event. Time-dependent Cox models were constructed to evaluate the association of incident ischemic event and mortality risk.During a median follow-up period of 2.9 years, 164 (9.3%) patients had at least 1 ischemic event. The crude incidence rate was 3.3% per year. Body mass index, prior myocardial infarction, insulin use, peripheral artery disease, hypertension, and current smoking were independent risk factors of ischemic event in HFpEF patients. HF hospitalization turned out to be an important trigger of ischemic event. Risk of ischemic event increased 4.7-fold (hazard ratio 4.70, 95% confidence interval: 2.23-9.89, p < 0.001) within the first month after the first HF hospitalization, and dropped rapidly thereafter. Incident ischemic event was associated with significant higher short-term risks of all-cause mortality and cardiovascular mortality.HFpEF patients from Americas were at a high risk of ischemic events, which was associated with mortality risk. A subset of baseline characteristics and HF hospitalization during follow-up could predict ischemic event.