University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen (UMG), Göttingen, Germany.
Int J Cardiol. 2018 Nov 15;271:132-139. doi: 10.1016/j.ijcard.2018.04.001. Epub 2018 Jul 7.
Comorbidities play a major role in heart failure. Whether prevalence and prognostic importance of comorbidities differ between heart failure with preserved ejection fraction (HFpEF), mid-range (HFmrEF) or reduced ejection fraction (HFrEF) is unknown.
Patients from index (n = 2516) and validation cohort (n = 1738) of The BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) were pooled. Eight non-cardiac comorbidities were assessed; diabetes mellitus, thyroid dysfunction, obesity, anaemia, chronic kidney disease (CKD, estimated glomerular filtration rate < 60 mL/min/1.73 m), COPD, stroke and peripheral arterial disease. Patients were classified based on ejection fraction. The association of each comorbidity with quality of life (QoL), all-cause mortality and hospitalisation was evaluated.
Patients with complete comorbidity data were included (n = 3499). Most prevalent comorbidity was CKD (50%). All comorbidities showed the highest prevalence in HFpEF, except for stroke. Prevalences of HFmrEF were in between the other entities. COPD was the comorbidity associated with the greatest reduction in QoL. In HFrEF, almost all were associated with a significant reduction in QoL, while in HFpEF only CKD and obesity were associated with a reduction. Most comorbidities in HFrEF were associated with an increased mortality risk, while in HFpEF only CKD, anaemia and COPD were associated with higher mortality risks.
The highest prevalence of comorbidities was seen in patients with HFpEF. Overall, comorbidities were associated with a lower QoL, but this was more pronounced in patients with HFrEF. Most comorbidities were associated with higher mortality risks, although the associations with diabetes were only present in patients with HFrEF.
合并症在心力衰竭中起着重要作用。心力衰竭射血分数保留（HFpEF）、中间范围（HFmrEF）或射血分数降低（HFrEF）患者中，合并症的患病率和预后重要性是否不同尚不清楚。
将生物学研究中的索引（n=2516）和验证队列（n=1738）中的患者合并入心力衰竭（BIOSTAT-CHF）的生物统计学靶向治疗中。评估了 8 种非心脏合并症；糖尿病、甲状腺功能障碍、肥胖、贫血、慢性肾脏病（肾小球滤过率<60 ml/min/1.73 m）、COPD、中风和外周动脉疾病。根据射血分数对患者进行分类。评估每种合并症与生活质量（QoL）、全因死亡率和住院的关系。
纳入了具有完整合并症数据的患者（n=3499）。最常见的合并症是 CKD（50%）。除中风外，所有合并症在 HFpEF 中患病率最高，HFmrEF 的患病率介于两者之间。COPD 是与 QoL 降低最相关的合并症。在 HFrEF 中，几乎所有合并症都与 QoL 显著降低相关，而在 HFpEF 中只有 CKD 和肥胖与 QoL 降低相关。HFpEF 中只有 CKD、贫血和 COPD 与更高的死亡率风险相关。
HFpEF 患者的合并症患病率最高。总的来说，合并症与较低的 QoL 相关，但在 HFrEF 患者中更为明显。大多数合并症与更高的死亡率风险相关，尽管与糖尿病的关联仅存在于 HFrEF 患者中。
