- •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.
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).
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).
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Internal Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Global burden of heart failure: A comprehensive and updated review of epidemiology.Cardiovasc Res. 2022; : cvac013https://doi.org/10.1093/cvr/cvac013
- Acute heart failure: Epidemiology, risk factors, and prevention.Rev Esp Cardiol (Engl Ed). 2015; 68: 245-248https://doi.org/10.1016/j.rec.2014.11.004
- Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure.Clin Res Cardiol. 2018; 107: 897-913https://doi.org/10.1007/s00392-018-1261-z
- Departments involved during the first episode of acute heart failure and subsequent emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort.Eur J Heart Fail. 2019; 21: 1231-1244https://doi.org/10.1002/ejhf.1567
- Temporal trends in mortality and readmission after acute heart failure: a systematic review and meta-regression in the past four decades.Eur J Heart Fail. 2021; 23: 420-431https://doi.org/10.1002/ejhf.2103
- Safety and the identification of modifiable factors in older patients discharged from the emergency department with acute heart failure.Emergencias. 2021; 33: 161-162
- Association between type-2 diabetes mellitus and post-discharge outcomes in heart failure patients: findings from the RICA registry.Diabetes Res Clin Pract. 2014; 104: 410-419https://doi.org/10.1016/j.diabres.2014.03.015
- Prognostic significance of obstructive coronary artery disease in patients admitted with acute decompensated heart failure: the ARIC study community surveillance.Eur J Heart Fail. 2022 Jul 18; https://doi.org/10.1002/ejhf.2617
- Impact of chronic obstructive pulmonary disease on clinical course after an episode of acute heart failure. EAHFE-COPD study.Int J Cardiol. 2017; 227: 450-456https://doi.org/10.1016/j.ijcard.2016.11.013
- Clinical characteristics and prognostic influence of renal dysfunction in heart failure patients with preserved ejection fraction.Eur J Intern Med. 2013; 24: 677-683https://doi.org/10.1016/j.ejim.2013.06.003
- Comorbidity in heart failure. results of the Spanish RICA registry.QJM. 2014; 107: 989-994https://doi.org/10.1093/qjmed/hcu127
- Prognostic impact of comorbidities in hospitalized patients with acute exacerbation of chronic heart failure.Eur J Intern Med. 2016; 34: 63-67https://doi.org/10.1016/j.ejim.2016.05.020
- Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: a systematic review and meta-analysis.Int J Cardiol. 2015; 196: 98-106https://doi.org/10.1016/j.ijcard.2015.05.180
- Thirty-day outcomes in frail older patients discharged home from the emergency department with acute heart failure: effects of high-risk criteria identified by the DEED FRAIL-AHF trial.Emergencias. 2021; 33: 165-173
- Trends in prevalence of comorbidities in heart failure clinical trials.Eur J Heart Fail. 2020; 22: 1032-1042https://doi.org/10.1002/ejhf.1818
- Paradox of obesity in heart failure: results from the Spanish RICA registry.Med Clin. 2011; 137 (Barc): 671-677https://doi.org/10.1016/j.medcli.2011.03.036
- Influence of potassium levels on one-year outcomes in elderly patients with acute heart failure.Eur J Intern Med. 2019; 60: 24-30https://doi.org/10.1016/j.ejim.2018.10.016
- Llorens P; members of the RICA and EAHFE registries. the utility of heart failure registries: a descriptive and comparative study of two heart failure registries.Postgrad Med J. 2016; 92: 260-266https://doi.org/10.1136/postgradmedj-2015-133739
- Acute heart failure in subtropical climates: clinical characteristics, management, and outcomes in the Canary Islands versus continental Spain - the CANAR-ICA study results.Emergencias. 2021; 33: 413-420
- Representación de los participantes del estudio del grupo de trabajo ICA-SEMES. characteristics and clinical course of patients with acute heart failure and the therapeutic measures applied in Spanish emergency departments: based on the EAHFE registry (epidemiology of acute heart failure in emergency departments).Emergencias. 2015; 27: 11-22
- Kathrine Skibelund a; ESC scientific document group. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur Heart J. 2021; 42: 3599-3726https://doi.org/10.1093/eurheartj/ehab368
- 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the european society of cardiology (ESC)Developed with the special contribution of the heart failure association (HFA) of the ESC.Eur Heart J. 2016; 37: 2129-2200https://doi.org/10.1093/eurheartj/ehw128
- Epidemiology of heart failure with preserved ejection fraction: Results from the RICA Registry.Med Clin. 2021; 157 (Barc): 1-9https://doi.org/10.1016/j.medcli.2020.05.059
- Different profiles of advanced heart failure among patients with and without diabetes mellitus. findings from the EPICTER study.Eur J Intern Med. 2022; 104: 59-65https://doi.org/10.1016/j.ejim.2022.07.014
- Renal function in patients with heart failure: prognostic value.Rev Clin Esp. 2012; 212: 119-126https://doi.org/10.1016/j.rce.2011.12.005
- Heart failure and liver disease: cardiohepatic interactions.JACC Heart Fail. 2019; 7: 87-97https://doi.org/10.1016/j.jchf.2018.10.007
- Cardiohepatic interactions: implications for management in advanced heart failure.Heart Fail Clin. 2016; 12: 349-361https://doi.org/10.1016/j.hfc.2016.03.011
- Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model.JAMA. 2003; 290: 2581-2587https://doi.org/10.1001/jama.290.19.2581
- Burden of valvular heart diseases: a population-based study.Lancet. 2006; 368: 1005-1011https://doi.org/10.1016/S0140-6736(06)69208-8
- Transcatheter versus surgical aortic-valve replacement in high-risk patients.N Engl J Med. 2011; 364: 2187-2198https://doi.org/10.1056/NEJMoa1103510
- Peripheral arterial disease and chronic heart failure: a dangerous mix.Heart Fail Rev. 2013; 18: 457-464https://doi.org/10.1007/s10741-012-9331-1
- Current Spanish emergency department organization and clinical practicesin caring for patients with acute heart failure.Emergencias. 2022; 34: 85-94
- Basal functional status predicts one-year mortality after a heart failure hospitalization in elderly patients - the RICA prospective study.Int J Cardiol. 2018; 254: 182-188https://doi.org/10.1016/j.ijcard.2017.10.104
- Management of acute decompensated heart failure in Spain: Where are we now?.Emergencias. 2022; 34: 81-82
Published online: March 12, 2023
Accepted: February 26, 2023
Received in revised form: February 24, 2023
Received: November 4, 2022
Publication stageIn Press Corrected Proof
© 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.