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. 2023 Jan;112(1):123-133.
doi: 10.1007/s00392-022-02076-1. Epub 2022 Aug 17.

Comorbidities complicating heart failure: changes over the last 15 years

Elles M Screever  1 , Martje H L van der Wal  1   2 , Dirk J van Veldhuisen  1 , Tiny Jaarsma  2 , Astrid Koops  1 , Kuna S van Dijk  1 , Janke Warink-Riemersma  1 , Jenifer E Coster  1 , B Daan Westenbrink  1 , Peter van der Meer  1 , Rudolf A de Boer  1 , Wouter C Meijers  3
Affiliations

Comorbidities complicating heart failure: changes over the last 15 years

Elles M Screever et al. Clin Res Cardiol. 2023 Jan.

Abstract

Aims: Management of comorbidities represents a critical step in optimal treatment of heart failure (HF) patients. However, minimal attention has been paid whether comorbidity burden and their prognostic value changes over time. Therefore, we examined the association between comorbidities and clinical outcomes in HF patients between 2002 and 2017.

Methods and results: The 2002-HF cohort consisted of patients from The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) trial (n = 1,032). The 2017-HF cohort were outpatient HF patients enrolled after hospitalization for HF in a tertiary referral academic hospital (n = 382). Kaplan meier and cox regression analyses were used to assess the association of comorbidities with HF hospitalization and all-cause mortality. Patients from the 2017-cohort were more likely to be classified as HF with preserved ejection fraction (24 vs 15%, p < 0.001), compared to patients from the 2002-cohort. Comorbidity burden was comparable between both cohorts (mean of 3.9 comorbidities per patient) and substantially increased with age. Higher comorbidity burden was significantly associated with a comparable increased risk for HF hospitalization and all-cause mortality (HR 1.12 [1.02-1.22] and HR 1.18 [1.05-1.32]), in the 2002- and 2017-cohort respectively. When assessing individual comorbidities, obesity yielded a statistically higher prognostic effect on outcome in the 2017-cohort compared to the 2002-HF cohort (p for interaction 0.026).

Conclusion: Despite major advances in HF treatment over the past decades, comorbidity burden remains high in HF and influences outcome to a large extent. Obesity emerges as a prominent comorbidity, and efforts should be made for prevention and treatment. Created with BioRender.com.

Keywords: Comorbidities; Heart failure; Hospitalization; Mortality; Obesity.

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Conflict of interest statement

The UMCG, which employs several of the authors has received research grants and/or fees from AstraZeneca, Abbott, Boehringer Ingelheim, Cardior Pharmaceuticals Gmbh, Ionis Pharmaceuticals, Inc., Novo Nordisk, and Roche. Dr. de Boer received speaker fees from Abbott, AstraZeneca, Bayer, Novartis, and Roche. All other authors report no disclosures.

Figures

Fig. 1
Fig. 1
Distribution of comorbidities in different age categories in A) 2002-HF cohort and B) 2017-HF cohort. Increasing color intensity represents higher number of comorbidities as shown in the legend
Fig. 2
Fig. 2
Kaplan-Meier curve for the combined endpoint (e.g. HF hospitalization and all-cause mortality), stratified by 2002- and 2017-HF cohort
Fig. 3
Fig. 3
Relationship between number of comorbidities and the estimated hazard ratio of the combined endpoint (e.g. HF hospitalization and all-cause mortality) in patients from the 2002-HF cohort (orange) and the 2017-HF cohort (dark green). Data is adjusted for the clinical risk model: age, sex, LVEF, sodium, log(NT-proBNP) and eGFR. The histogram represents the percentage of patients with that specific number of comorbidities
Fig. 4
Fig. 4
Forest plot showing the hazard ratio [95% CI] associated with individual comorbidities to the primary combined endpoint. Data is adjusted for the clinical risk model: age, sex, LVEF, sodium, log(NT-proBNP) and eGFR. p-values for interaction refer to interaction term between 2002- and 2017-HF cohort and respective comorbidity. Bold values denote statistical significance at the p < 0.10 level for interaction terms and p < 0.05 level for all other analyses
See this image and copyright information in PMC

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