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Prevalence and prognostic impact of non‐cardiac co‐morbidities in heart failure outpatients with preserved and reduced ejection fraction: a community‐based study
Author(s) -
Iorio Annamaria,
Senni Michele,
Barbati Giulia,
Greene Stephen J.,
Poli Stefano,
Zambon Elena,
Di Nora Concetta,
Cioffi Giovanni,
Tarantini Luigi,
Gavazzi Antonello,
Sinagra Gianfranco,
Di Lenarda Andrea
Publication year - 2018
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1202
Subject(s) - medicine , ejection fraction , heart failure , hazard ratio , cardiology , interquartile range , heart failure with preserved ejection fraction , population , cohort , confidence interval , environmental health
Aim To assess adverse outcomes attributable to non‐cardiac co‐morbidities and to compare their effects by left ventricular ejection fraction (LVEF) group [LVEF <50% (heart failure with reduced ejection fraction, HFrEF), LVEF ≥50% (heart failure with preserved ejection fraction, HFpEF)] in a contemporary, unselected chronic heart failure population. Methods and results This community‐based cohort enrolled patients from October 2009 to December 2013. Adjusted hazard ratio (HR) and the population attributable fraction (PAF) were used to compare the contribution of 15 non‐cardiac co‐morbidities to adverse outcome. Overall, 2314 patients (mean age 77 ±10 years, 57% men) were recruited [ n = 941 (41%) HFrEF, n = 1373 (59%) HFpEF]. Non‐cardiac co‐morbidity rates were similarly high, except for obesity and hypertension which were more prevalent in HFpEF. At a median follow‐up of 31 (interquartile range 16–41) months, 472 (20%) patients died. Adjusted mortality rates were not significantly different between the HFrEF and HFpEF groups. After adjustment, an increasing number of non‐cardiac co‐morbidities was associated with a higher risk for all‐cause mortality [HR 1.25; 95% confidence interval (CI) 1.10–1.26; P < 0.001], all‐cause hospitalization (HR 1.17; 95% CI 1.12–1.23; P < 0.001), heart failure hospitalization (HR 1.28; 95% CI 1.19–1.38; P < 0.001), non‐cardiovascular hospitalization (HR 1.16; 95% CI 1.11–1.22; P < 0.001). The co‐morbidities contributing to high PAF were: anaemia, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, and peripheral artery disease. These findings were similar for HFrEF and HFpEF. Interaction analysis yielded similar results. Conclusions In a contemporary community population with chronic heart failure, non‐cardiac co‐morbidities confer a similar contribution to outcomes in HFrEF and HFpEF. These observations suggest that quality improvement initiatives aimed at optimizing co‐morbidities may be similarly effective in HFrEF and HFpEF.