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. 2023 Sep 20;30(13):1346-1358.
doi: 10.1093/eurjpc/zwad151.

Comprehensive characterization of non-cardiac comorbidities in acute heart failure: an analysis of ESC-HFA EURObservational Research Programme Heart Failure Long-Term Registry

Ovidiu Chioncel  1   2 , Lina Benson  3 , Maria G Crespo-Leiro  4 , Stefan D Anker  5   6 , Andrew J S Coats  7 , Gerasimos Filippatos  8   9 , Theresa McDonagh  10   11 , Cornelia Margineanu  1   2 , Alexandre Mebazaa  12 , Marco Metra  13 , Massimo F Piepoli  14   15 , Marianna Adamo  13 , Giuseppe M C Rosano  16   17 , Frank Ruschitzka  18 , Gianluigi Savarese  3 , Petar Seferovic  19   20 , Maurizio Volterrani  21 , Roberto Ferrari  22 , Aldo P Maggioni  23 , Lars H Lund  24   25
Affiliations

Comprehensive characterization of non-cardiac comorbidities in acute heart failure: an analysis of ESC-HFA EURObservational Research Programme Heart Failure Long-Term Registry

Ovidiu Chioncel et al. Eur J Prev Cardiol. .

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Eur J Prev Cardiol. 2024 Jan 25;31(2):274. doi: 10.1093/eurjpc/zwad396. Eur J Prev Cardiol. 2024. PMID: 38195099 No abstract available.

Abstract

Aims: To evaluate the prevalence and associations of non-cardiac comorbidities (NCCs) with in-hospital and post-discharge outcomes in acute heart failure (AHF) across the ejection fraction (EF) spectrum.

Methods and results: The 9326 AHF patients from European Society of Cardiology (ESC)-Heart Failure Association (HFA)-EURObservational Research Programme Heart Failure Long-Term Registry had complete information for the following 12 NCCs: anaemia, chronic obstructive pulmonary disease (COPD), diabetes, depression, hepatic dysfunction, renal dysfunction, malignancy, Parkinson's disease, peripheral vascular disease (PVD), rheumatoid arthritis, sleep apnoea, and stroke/transient ischaemic attack (TIA). Patients were classified by number of NCCs (0, 1, 2, 3, and ≥4). Of the AHF patients, 20.5% had no NCC, 28.5% had 1 NCC, 23.1% had 2 NCC, 15.4% had 3 NCC, and 12.5% had ≥4 NCC. In-hospital and post-discharge mortality increased with number of NCCs from 3.0% and 18.5% for 1 NCC to 12.5% and 36% for ≥4 NCCs.Anaemia, COPD, PVD, sleep apnoea, rheumatoid arthritis, stroke/TIA, Parkinson, and depression were more prevalent in HF with preserved EF (HFpEF). The hazard ratio (95% confidence interval) for post-discharge death for each NCC was for anaemia 1.6 (1.4-1.8), diabetes 1.2 (1.1-1.4), kidney dysfunction 1.7 (1.5-1.9), COPD 1.4 (1.2-1.5), PVD 1.2 (1.1-1.4), stroke/TIA 1.3 (1.1-1.5), depression 1.2 (1.0-1.5), hepatic dysfunction 2.1 (1.8-2.5), malignancy 1.5 (1.2-1.8), sleep apnoea 1.2 (0.9-1.7), rheumatoid arthritis 1.5 (1.1-2.1), and Parkinson 1.4 (0.9-2.1). Anaemia, kidney dysfunction, COPD, and diabetes were associated with post-discharge mortality in all EF categories, PVD, stroke/TIA, and depression only in HF with reduced EF, and sleep apnoea and malignancy only in HFpEF.

Conclusion: Multiple NCCs conferred poor in-hospital and post-discharge outcomes. Ejection fraction categories had different prevalence and risk profile associated with individual NCCs.

Keywords: Acute heart failure; Comorbidities; Prognosis.

Plain language summary

The current analysis from ESC-Heart Failure Long-Term Registry represents the largest and most comprehensive study in an acute heart failure (AHF) population with HF with reduced ejection fraction (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF), on prevalence and association with in-hospital and post-discharge outcomes of a large number of non-cardiac comorbidities.A greater number of non-cardiac comorbidities (CNNs) were associated at admission with older age, preserved EF, more severe NYHA class, and longer duration of HF. In-hospital and post-discharge mortality gradually increased with number of CNNs.The association between each individual comorbidity and post-discharge outcomes varied substantially in AHF patients with HFrEF, HFmrEF, and HFpEF, suggesting that an ‘EF-specific’ multidisciplinary approach with distinct comorbidity management programs should be applied in post-discharge phase.

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Conflict of interest statement

Conflict of interest: O. Chioncel declare no conflict of interest related to present work; ESC meeting support from Servier. L. Benson declare no conflict of interest. M. Crespo-Leiro reports unrelated to the present work: consultancy or speaker's honoraria from Novartis, AstraZeneca, Boehringer Ingelheim, Abbott, Medtronic, CareDx, Astellas and Vifor Pharma. S.D. Anker reports unrelated to the present work: Grants or contracts: Vifor Int, Abbott Vascular; Consulting fees: CVRx, Amgen, Respicardia, Novo Nordisk, Brahms, Novartis, Sanofi, Cordio; Leadership or fiduciary role in other board: Abbott Vascular, Astra Zeneca, Bayer AG, Bioventrix, Boehringer Ingelheim, Cardiac Dimension, Cardior, Impulse Dynamics, Janssen, Occlutech, Servier, Vifor Int, and V-Wave. A.J.S. Coats reports unrelated to the present work: speaker's honoraria from: Astra Zeneca, Bayer, Boehringer Ingelheim, Edwards, Menarini, Novartis, Servier, Vifor, Abbott, Actimed, Arena, Cardiac Dimensions, Corvia, CVRx, Enopace, ESN Cleer, Faraday, Impulse Dynamics, Respicardia, and Viatris. G. Filippatos reports lecture fees and/or committee membership in trials sponsored by Bayer, Vifor, Medtronic, Novartis, Servier, Boehringer Ingelheim, and research support from the European Union. T. McDonagh reports unrelated to the present work: speaker's honoraria from Abbot, Astra Zeneca, Boeringher Ingelheim and Edwards. C. Margineanu none related to the present work. A. Mebazaa reports unrelated to the present work: Grants or contracts from and consulting fees from Roche, 4TEEN4, Corteria; speaker's honoraria from MSD; Patents: S-Form Pharma. M. Metra reports personal fees from Amgen, AstraZeneca, Abbott Vascular, Bayer, Edwards Therapeutics, Livanova, Vifor Pharma, as member of Trials' Committees or advisory boards or for speeches at sponsored meetings in the last 3 years. M. Piepoli reports unrelated to the present work: consultancy, speaker's, institutional fees from Astra-Zeneca, Boehringer- Ingelheim, CHF solution, Menarini, Novartis, Servier M. Adammo reports speaker fees from Abbott Vascular and Medtronic. G.M.C. Rosano declare no conflict of interest. F. Ruschitzka has not received personal payments by pharmaceutical companies or device manufacturers in the last 3 years (remuneration for the time spent in activities, such as participation as steering committee member of clinical trials and member of the Pfizer Research Award selection committee in Switzerland, were made directly to the University of Zurich). The Department of Cardiology (University Hospital of Zurich/University of Zurich) reports research-, educational- and/or travel grants from Abbott, Amgen, Astra Zeneca, Bayer, Berlin Heart, B. Braun, Biosense Webster, Biosensors Europe AG, Biotronik, BMS, Boehringer Ingelheim, Boston Scientific, Bracco, Cardinal Health Switzerland, Corteria, Daiichi, Diatools AG, Edwards Lifesciences, Guidant Europe NV (BS), Hamilton Health Sciences, Kaneka Corporation, Kantar, Labormedizinisches Zentrum, Medtronic, MSD, Mundipharma Medical Company, Novartis, Novo Nordisk, Orion, Pfizer, Quintiles Switzerland Sarl, Roche Diagnostics, Sahajanand IN, Sanofi, Sarstedt AG, Servier, SIS Medical, SSS International Clinical Research, Terumo Deutschland, Trama Solutions, V- Wave, Vascular Medical, Vifor, Wissens Plus, ZOLL. The research and educational grants do not impact on Prof. Ruschitzka`s personal remuneration. G. Savarese reports unrelated to the present work: Grants or contracts: Vifor Pharma, Boehringer Ingelheim, Astra Zeneca, Merck, Cytokinetics; Consulting fees: Societa' Prodotti Antibiotici, Medical Education Global Solutions, Genesis, Agence Recherche (ANR); speaker's honoraria: Servier, Cytokinetics, Medtronic, Dynamicom Education, Vifor Pharma; Support for attending meetings: Boehringer Ingelheim; Data Safety Monitoring Bord or Advisory Board: Astra Zeneca, Uppsala Clinical Research Center, Servier. P. Seferovic reports unrelated to the present work: speaker's honoraria from Servier, Astra Zeneca, Menarini, Boehringer Ingelheim, Novartis and Roche diagnostic. M. Volterrani: none related to the present work. R. Ferrari reports unrelated to the present work: speaker's honoraria and support for attending meetings: Servier International, Merck Serono, Lupin, Sunpharma, Reddys Ltd; leadership or fiduciary role in other board: Scientific Director of Medical Trial Analysis. A. Maggioni: personal fees from AstraZeneca, Bayer, Fresenius, Novartis, outside the submitted work. L.H. Lund is supported by Supported by Karolinska Institutet, the Swedish Research Council [grant 523-2014-2336], the Swedish Heart Lung Foundation [grants 20150557, 20190310], and the Stockholm County Council [grants 20170112, 20190525] and reports unrelated to the present work: Grants: AstraZeneca, Vifor, Boston Scientific, Boehringer Ingelheim, Novartis, MSD; Consulting: Vifor, AstraZeneca, Bayer, Pharmacosmos, MSD, MedScape, Sanofi, Lexicon, Myokardia, Boehringer Ingelheim, Servier, Edwards Life Sciences, Alleviant; Speaker's honoraria: Abbott, OrionPharma, MedScape, Radcliffe, AstraZeneca, Novartis, Boehringer Ingelheim, Bayer; Patent: AnaCardio; Stock ownership: AnaCardio.

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