Clusters of Comorbidities in the Short-Term Prognosis of Acute Heart Failure among Elderly Patients: A Retrospective Cohort Study

Abstract

Background and Objectives: Elderly patients affected by acute heart failure (AHF) often show different patterns of comorbidities. In this paper, we aimed to evaluate how chronic comorbidities cluster and which pattern of comorbidities is more strongly related to in-hospital death in AHF. Materials and Methods: All patients admitted for AHF to an Internal Medicine Department (01/2015–01/2019) were retrospectively evaluated; the main outcome of this study was in-hospital death during an admission for AHF; age, sex, the Charlson comorbidity index (CCI), and 17 different chronic pathologies were investigated; the association between the comorbidities was studied with Pearson’s bivariate test, considering a level of p ≤ 0.10 significant, and considering p < 0.05 strongly significant. Thus, we identified the clusters of comorbidities associated with the main outcome and tested the CCI and each cluster against in-hospital death with logistic regression analysis, assessing the accuracy of the prediction with ROC curve analysis. Results: A total of 459 consecutive patients (age: 83.9 ± 8.02 years; males: 56.6%). A total of 55 (12%) subjects reached the main outcome; the CCI and 16 clusters of comorbidities emerged as being associated with in-hospital death from AHF. Of these, CCI and six clusters showed an accurate prediction of in-hospital death. Conclusions: Both the CCI and specific clusters of comorbidities are associated with in-hospital death from AHF among elderly patients. Specific phenotypes show a greater association with a worse short-term prognosis than a more generic scale, such as the CCI.

Safety, tolerability and efficacy of up‐titration of guideline‐directed medical therapies for acute heart failure in elderly patients: A sub‐analysis of the STRONG‐HF randomized clinical trial

“…Hence, less than 20% of patients were older than 75 years and patients with age >85 years were not included in the trial, which impairs the ability to draw conclusions for very old patients. In very old patients, the impact of frailty and the burden of non‐cardiovascular comorbidities might substantially determine the clinical course after AHF hospitalization, reducing the proportion of HF‐related compared to non‐HF‐related hospitalizations and scaling down the benefits of GDMT 37,38 …”

“…In very old patients, the impact of frailty and the burden of non-cardiovascular comorbidities might substantially determine the clinical course after AHF hospitalization, reducing the proportion of HF-related compared to non-HF-related hospitalizations and scaling down the benefits of GDMT. 37,38 . .…”