Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
Am J Cardiol. 2022 Sep 15;179:51-57. doi: 10.1016/j.amjcard.2022.06.013. Epub 2022 Jul 20.
The prevalence of heart failure (HF) and co-morbidities are increasing. The prognostic impact of interaction between co-morbidity and HF remains unknown. The purpose of the present study was to examine if HF interacts with co-morbidity burden to increase mortality. We conducted a cohort study of all adult Danish patients (aged ≥18 years) with a hospital inpatient or outpatient clinic diagnosis of HF (n = 252,726) between 1995 and 2016. We matched each patient with up to 3 members of the general population without a history of HF (n = 744,372). Noncardiac co-morbidities were assessed using the Charlson co-morbidity index and were defined by 4 categories of co-morbidity: 0 (none), 1 (low), 2 to 3 (moderate), and ≥4 (severe). Cardiac co-morbidities were assessed individually. Among patients with HF with severe co-morbidity, 42% of the mortality rate during 30 days of follow-up was explained by the interaction with co-morbidity. The interaction effect was also substantial in patients with moderate (31%) and low co-morbidity burden (16%). During 31 to 365 days of follow-up, interaction effects were 1% for low co-morbidity, 8% for moderate co-morbidity, and 22% for severe co-morbidity. Beyond 1 year of follow-up, no interaction effect was observed. With the exception of cardiomyopathy, cardiac co-morbidities did not interact substantially with HF during the first year of follow-up. During longer follow-up, pulmonary hypertension, cardiomyopathy, and endocarditis showed interaction. In conclusion, noncardiac co-morbidities had biological interaction with HF that increased short-term mortality substantially beyond the individual effects of HF and co-morbidity.
心力衰竭（HF）和合并症的患病率正在增加。合并症与 HF 之间相互作用的预后影响尚不清楚。本研究的目的是检验 HF 是否与合并症负担相互作用，从而增加死亡率。我们对 1995 年至 2016 年间所有丹麦成年住院或门诊 HF 患者（年龄≥18 岁）进行了队列研究（n=252726）。我们为每位患者匹配了多达 3 名无 HF 病史的普通人群成员（n=744372）。使用 Charlson 合并症指数评估非心脏合并症，并将其定义为 4 个合并症类别：0（无）、1（低）、2-3（中）和≥4（高）。评估了心脏合并症。在严重合并症的 HF 患者中，30 天随访期间，42%的死亡率归因于合并症之间的相互作用。在中度（31%）和低合并症负担（16%）患者中，这种相互作用的影响也很大。在 31 至 365 天的随访期间，低合并症的交互作用效应为 1%，中度合并症为 8%，严重合并症为 22%。在随访 1 年以上时，未观察到交互作用。除了心肌病外，在随访的第一年，心脏合并症与 HF 之间没有明显的相互作用。在较长的随访期间，肺动脉高压、心肌病和心内膜炎表现出相互作用。总之，非心脏合并症与 HF 之间存在生物学相互作用，除了 HF 和合并症的个体影响之外，还大大增加了短期死亡率。
