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Original research
Coronary risk stratification of patients with newly diagnosed heart failure
  1. Rasmus Bo Hasselbalch1,
  2. Mia Pries-Heje1,
  3. Thomas Engstrøm2,
  4. Andreas Sandø1,
  5. Merete Heitmann3,
  6. Frants Pedersen2,
  7. Morten Schou1,
  8. Hans Mickley4,
  9. Hanne Elming5,
  10. Rolf Steffensen6,
  11. Lars Koeber2 and
  12. Kasper Karmark Iversen1
  1. 1Department of Cardiology, Herlev og Gentofte Hospital, Herlev, Denmark
  2. 2Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
  3. 3Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
  4. 4Department of Cardiology, Odense University Hospital, Odense, Denmark
  5. 5Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark
  6. 6Department of Cardiology, Nordsjaellands Hospital, Hilleroed, Denmark
  1. Correspondence to Dr Rasmus Bo Hasselbalch; rasmus.bo.hasselbalch{at}regionh.dk

Abstract

Objective Coronary artery disease (CAD) is frequent in patients with newly diagnosed heart failure (HF). Multislice CT (MSCT) is a non-invasive alternative to coronary angiography (CAG) suggested for patients with a low-to-intermediate risk of CAD. No established definition of such patients exists. Our purpose was to develop a simple score to identify as large a group as possible with a suitable pretest risk of CAD.

Methods Retrospective study of patients in Denmark undergoing CAG due to newly diagnosed HF from 2010 to 2014. All Danish patients were registered in two databases according to geographical location. We used data from one registry and multiple logistic regression with backwards elimination to find predictors of CAD and used the derived OR to develop a clinical risk score called the CT-HF score, which was subsequently validated in the other database.

Results The main cohort consisted of 2171 patients and the validation cohort consisted of 2795 patients with 24% and 27% of patients having significant CAD, respectively. Among significant predictor, the strongest was extracardiac arteriopathy (OR 2.84). Other significant factors were male sex, smoking, hyperlipidaemia, diabetes mellitus, angina and age. A proposed cut-off of 9 points identified 61% of patients with a 15% risk of having CAD, resulting in an estimated savings of 15% of the cost and 21% of the radiation.

Conclusions A simple score based on clinical risk factors could identify HF patients with a low risk of CAD; these patients may have benefitted from MSCT as a gatekeeper for CAG.

  • coronary artery disease
  • heartfailure

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Footnotes

  • Contributors The study was designed by RBH and KKI. Data collection was handled by RBH, MP-H, TE, AS, MH, FP, MS, HM, HE, RS and LK. KKI and RBH did the data analyses, LK and MS helped with data interpretation. RBH and KKI wrote the first manuscript. All the authors critically revised the manuscript and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study complied with the Declaration of Helsinki II and was approved by the Danish Data Protection Agency (j.nr. 2014-41-3656) and the Danish Health and Medicines Authority (3-3013-1178/1), who determined no patient consent was necessary under Danish law.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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