Premium
Association between cardiovascular vs. non‐cardiovascular co‐morbidities and outcomes in heart failure with preserved ejection fraction
Author(s) -
Lund Lars H.,
Donal Erwan,
Oger Emmanuel,
Hage Camilla,
Persson Hans,
HaugenLöfman Ida,
Ennezat PierreVladimir,
SportouchDukhan Catherine,
Drouet Elodie,
Daubert JeanClaude,
Linde Cecilia
Publication year - 2014
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.137
Subject(s) - medicine , cardiology , heart failure , atrial fibrillation , ejection fraction , hazard ratio , interquartile range , heart failure with preserved ejection fraction , framingham heart study , diabetes mellitus , proportional hazards model , framingham risk score , disease , confidence interval , endocrinology
Aims The prevalence of cardiovascular and non‐cardiovascular co‐morbidities and their relative importance for outcomes in heart failure with preserved ejection fraction ( HFPEF ) remain poorly characterized. This study aimed to investigate this. Methods and results The Karolinska–Rennes ( KaRen ) Study was a multinational prospective observational study designed to characterize HFPEF . Inclusion required acute HF , defined by the Framingham criteria, LVEF ≥45%, and NT ‐pro‐ BNP ≥300 ng/L or BNP ≥100 ng/L. Detailed clinical data were collected at baseline and patients were followed prospectively for 18 months. Predictors of the primary ( HF hospitalization or all‐cause mortality) and secondary (all‐cause mortality) outcomes were assessed with multivariable Cox regression. A total of 539 patients [56% women; median (interquartile range) age 79 (72–84) years; NT ‐pro‐ BNP / BNP 2448 (1290–4790)/429 (229–805) ng/L] were included. Known history of HF was present in 40%. Co‐morbidities included hypertension (78%), atrial fibrillation/flutter (65%), anaemia (51%), renal dysfunction (46%), CAD (33%), diabetes (30%), lung disease (25%), and cancer (16%). The primary outcome occurred in 268 patients [50%; 106 deaths (20%) and 162 HF hospitalizations (30%)]. Important independent predictors of the primary and/or secondary outcomes were age, history of non‐cardiovascular syncope, valve disease, anaemia, lower sodium, and higher potassium, but no cardiovascular co‐morbidities. Renin–angiotensin system antagonist and mineralocorticoid receptor antagonist use predicted improved prognosis. Conclusion HFPEF was associated with higher age, female gender, hypertension, atrial fibrillation/flutter, and numerous non‐cardiovascular co‐morbidities. Prognosis was determined by non‐cardiovascular co‐morbidities, but use of conventional heart failure medications may still be associated with improved outcomes.