Wereldwijde HF-registry: FEV1 is een onafhankelijke prognostische factor — pleidooi voor routine-spirometrie bij hartfalen

Aims: Pulmonary abnormalities are common in HF and may have prognostic implications. Current evidence is largely limited to high-income countries. We examined the relationship between forced expiratory volume in 1 second (FEV1), HF burden and long-term clinical outcomes in a diverse multinational HF cohort. Methods: Sub-study within the multinational Global Congestive Heart Failure registry, which collected clinical data including spirometry from HF participants in 28 high-, middle- and low-income countries; followed for median 3.8 years (IQR 2.1–5.0). Baseline FEV1 was transformed into z-scores standardised for age, sex, and height. The association between baseline FEV1 with all-cause mortality, cardiovascular (CV) deaths and all-cause hospitalisations were examined. Results: 3,359 HF participants (mean age 61.9 [SD 14.1] years, 66.4% males). Participants with lower FEV1 z-scores even within the normal range (z >-2) showed increasing HF burden, cardiac structural and functional impairment, and lower health-related quality of life. FEV1 z-score ≤-2 was independently associated with higher risks of all-cause mortality (HR 2.20; 95% CI 1.61–3.01), CV mortality (HR 2.45; 95% CI 1.64–3.66) and hospitalisations (HR 1.40; 95% CI 1.12–1.74). Effect sizes were comparable to other major prognostic factors. Associations were consistent across populations from diverse socio-economic development, HF aetiology and HF type. Conclusions: FEV1 is a major, independent prognostic factor in HF across global populations. Routine spirometry deserves a place in the HF workup alongside conventional risk stratification.