Co‐morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey

Abstract

Aims Co‐morbidities frequently accompany heart failure (HF), contributing to increased morbidity and mortality, and an impairment of quality of life. We assessed the prevalence, determinants, regional variation, and prognostic implications of co‐morbidities in patients with chronic HF in Europe. Methods and results A total of 3226 European outpatients with chronic HF were included in this analysis of the European Society of Cardiology (ESC) Heart Failure Pilot Survey. The following co‐morbidities were considered: diabetes, hyper‐ and hypothyroidism, stroke, COPD, sleep apnoea, chronic kidney disease (CKD), and anaemia. Prognostic implications of co‐morbidities were evaluated using population attributable risks (PARs), and patients were divided into geographic regions. Clinical endpoints were all‐cause mortality and HF hospitalization. The majority of patients (74%) had a least one co‐morbidity, the most prevalent being CKD (41%), anaemia (29%), and diabetes (29%). Co‐morbidities were independently associated with higher age (P < 0.001), higher NYHA functional class (P < 0.001), ischaemic aetiology of HF (P < 0.001), higher heart rate (P = 0.011), history of hypertension (P < 0.001), and AF (P < 0.001). Only diabetes, CKD, and anaemia were independently associated with a higher risk of mortality and/or HF hospitalization. There were marked regional differences in prevalence and prognostic implications of co‐morbidities. Prognostic implications of co‐morbidities (PARs) were: CKD = 41%, anaemia = 37%, diabetes = 14%, COPD = 10%, and <10% for all other co‐morbidities. Conclusion In this pilot survey, co‐morbidities are prevalent in patients with chronic HF and are related to the severity of the disease. The presence of diabetes, CKD, and anaemia was independently related to increased mortality and HF hospitalization, with the highest PAR for CKD and anaemia.

Comorbidity-adjusted relative survival in newly hospitalized heart failure patients: A population-based study

“…HF subjects typically suffer from a number of coexisting diseases that may influence the outcomes of care [2,3,15]. To the best of our knowledge, this is the first study (i) investigating a comprehensive search of comorbidities based on administrative data, (ii) assessing their impact on short-term survival, and (iii) trying to disentangle between mortality associated with HF from that due to all other causes through a relative survival approach.…”

“…HF is commonly accompanied by a broad range of comorbidities, with chronic kidney disease, anaemia and diabetes being the most prevalent, which further complicate the management of care, unfavourably affecting prognosis [2,3].…”

Characteristics and outcomes of heart failure hospitalization before implementation of a heart failure clinic: The PRECIC study

“…16 Of note, the prevalences of the two commonest comorbidities, hypertension and diabetes, in our study were similar to that report; this is not the case for AF, which was twice as common in the present study. 16 Patients with more than three comorbidities have a higher risk of death and HF hospitalization, as shown by van Deursen et al, 23 although in their study only noncardiovascular comorbidities were analyzed. Another study, on incident HF, reported that patients with HFpEF were more likely to have both cardiac and non-cardiac comorbidities.…”

Spontaneous atrial fibrillation after long-term transesophageal atrial burst pacing in rats. Technical and procedural approach to a new in vivo atrial fibrillation model

“…The protocol can easily be applied in other clinically-relevant models (e.g. models of diseases known to be associated with increased risk of AF, such as aging and hypertension, heart failure, or obesity [8,[13][14][15]), or in animals treated with drugs commonly used in AF patients.…”