Highlights
- •Heart failure associated comorbidities exert a different effect on all-cause mortality.
- •Liver cirrhosis (LC) is the comorbidity that most increases the risk of death.
- •Valvular heart disease (VHD) is the second comorbidity that most increases mortality.
- •The impact of LC and VHD on prognosis is consistent for the 3 categories of ejection fraction.
Abstract
Objective
The role of comorbidities in heart failure (HF) outcome has been previously investigated,
although mostly individually. We investigated the individual effect of 13 comorbidities
on HF prognosis and looked for differences according to left-ventricular ejection
fraction (LVEF), classified as reduced (HFrEF), mildly-reduced (HFmrEF) and preserved
(HFpEF).
Methods
We included patients from the EAHFE and RICA registries and analysed the following
comorbidities: hypertension, dyslipidaemia, diabetes mellitus (DM), atrial fibrillation
(AF), coronary artery disease (CAD), chronic kidney disease (CKD), chronic obstructive
pulmonary disease (COPD), heart valve disease (HVD), cerebrovascular disease (CVD),
neoplasia, peripheral artery disease (PAD), dementia and liver cirrhosis (LC). Association
of each comorbidity with all-cause mortality was assessed by an adjusted Cox regression
analysis that included the 13 comorbidities, age, sex, Barthel index, New York Heart
Association functional class and LVEF and expressed as adjusted Hazard Ratios (HR)
with 95% confidence intervals (95%CI).
Results
We analysed 8,336 patients (82 years-old; 53% women; 66% with HFpEF). Mean follow-up
was 1.0 years. Respect to HFrEF, mortality was lower in HFmrEF (HR:0.74;0.64-0.86)
and HFpEF (HR:0.75;0.68-0.84). Considering patients all together, eight comorbidities
were associated with mortality: LC (HR:1.85;1.42-2.42), HVD (HR:1.63;1.48-1.80), CKD
(HR:1.39;1.28-1.52), PAD (HR:1.37;1.21-1.54), neoplasia (HR:1.29;1.15-1.44), DM (HR:1.26;1.15-1.37),
dementia (HR:1.17;1.01-1.36) and COPD (HR:1.17;1.06-1.29). Associations were similar
in the three LVEF subgroups, with LC, HVD, CKD and DM remaining significant in the
three subgroups.
Conclusion
HF comorbidities are associated differently with mortality, LC being the most associated
with mortality. For some comorbidities, this association can be significantly different
according to the LVEF.
Keywords
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Article info
Publication history
Published online: March 12, 2023
Accepted:
February 26,
2023
Received in revised form:
February 24,
2023
Received:
November 4,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
