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Preheart failure comorbidities and impact on prognosis in heart failure patients: a nationwide study
Author(s) -
Christiansen M. N.,
Køber L.,
TorpPedersen C.,
Gislason G. H.,
Schou M.,
Smith J. G.,
Vasan R. S.,
Andersson C.
Publication year - 2020
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.13033
Subject(s) - medicine , heart failure , comorbidity , hazard ratio , population , pediatrics , confidence interval , environmental health
Background Data regarding the impact of preheart failure (HF) comorbidities on the prognosis of HF are scarce, especially in the younger HF patients. Objectives To investigate pre‐existing comorbidities in HF patients versus matched controls and to assess their impact on mortality. Methods We included all first‐time in‐hospital and outpatient diagnoses of HF from 1995 to 2017, and comorbidities antedating the HF‐diagnosis in the Danish nationwide registries. HF patients were matched with up to five controls. One‐year all‐cause mortality rates and population attributable risk (PAR) were estimated for three separate age groups (≤50, 51–74 and >74 years). Results Totally 280 002 patients with HF and 1 166 773 controls were included. Cardiovascular comorbidities, for example, cerebrovascular disease and ischaemic heart disease were more frequent in the oldest (17.9% and 29.7% in HF vs. 9.8% and 10.7% in controls) compared to the youngest age group (3.9% and 15.2% in HF vs. 0.7% and 0.9% in controls). Amongst patients with HF, 1‐year mortality rates (per 100 person‐years) were highest amongst those with >1 noncardiovascular comorbidity: ≤50 years (10.4; 9.64–11.3), 51–74 years (23.3; 22.9–23.7), >74 years (58.5; 57.9–59.0); hazard ratios 245.18 (141.45–424.76), 45.85 (42.77–49.15) and 24.5 (23.64–25.68) for those ≤50, 51–74 and >74 years, respectively. For HF patients ≤50 years, PAR was greatest for hypertension (17.8%), cancer (14.1%) and alcohol abuse (8.5%). For those aged >74 years, PAR was greatest for hypertension (23.6%), cerebrovascular disease (6.2%) and cancer (7.2%). Conclusions Heart failure patients had a higher burden of pre‐existing comorbidities, compared to controls, which adversely impacted prognosis, especially in the young.