Emergency Department Hospital Clinic Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain.
Internal Medicine Department, University Hospital of Gran Canaria (Dr. Negrín), Spain.
Eur J Intern Med. 2023 May;111:97-104. doi: 10.1016/j.ejim.2023.02.026. Epub 2023 Mar 12.
The role of comorbidities in heart failure (HF) outcome has been previously investigated, although mostly individually. We investigated the individual effect of 13 comorbidities on HF prognosis and looked for differences according to left-ventricular ejection fraction (LVEF), classified as reduced (HFrEF), mildly-reduced (HFmrEF) and preserved (HFpEF).
We included patients from the EAHFE and RICA registries and analysed the following comorbidities: hypertension, dyslipidaemia, diabetes mellitus (DM), atrial fibrillation (AF), coronary artery disease (CAD), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), heart valve disease (HVD), cerebrovascular disease (CVD), neoplasia, peripheral artery disease (PAD), dementia and liver cirrhosis (LC). Association of each comorbidity with all-cause mortality was assessed by an adjusted Cox regression analysis that included the 13 comorbidities, age, sex, Barthel index, New York Heart Association functional class and LVEF and expressed as adjusted Hazard Ratios (HR) with 95% confidence intervals (95%CI).
We analysed 8,336 patients (82 years-old; 53% women; 66% with HFpEF). Mean follow-up was 1.0 years. Respect to HFrEF, mortality was lower in HFmrEF (HR:0.74;0.64-0.86) and HFpEF (HR:0.75;0.68-0.84). Considering patients all together, eight comorbidities were associated with mortality: LC (HR:1.85;1.42-2.42), HVD (HR:1.63;1.48-1.80), CKD (HR:1.39;1.28-1.52), PAD (HR:1.37;1.21-1.54), neoplasia (HR:1.29;1.15-1.44), DM (HR:1.26;1.15-1.37), dementia (HR:1.17;1.01-1.36) and COPD (HR:1.17;1.06-1.29). Associations were similar in the three LVEF subgroups, with LC, HVD, CKD and DM remaining significant in the three subgroups.
HF comorbidities are associated differently with mortality, LC being the most associated with mortality. For some comorbidities, this association can be significantly different according to the LVEF.
先前已经研究了合并症在心力衰竭（HF）结局中的作用，尽管大多是单独研究的。我们研究了 13 种合并症对 HF 预后的单独影响，并根据左心室射血分数（LVEF）进行了分类，分为射血分数降低（HFrEF）、射血分数轻度降低（HFmrEF）和射血分数保留（HFpEF），寻找差异。
我们纳入了来自 EAHFE 和 RICA 登记处的患者，并分析了以下合并症：高血压、血脂异常、糖尿病（DM）、心房颤动（AF）、冠状动脉疾病（CAD）、慢性肾脏病（CKD）、慢性阻塞性肺疾病（COPD）、心脏瓣膜疾病（HVD）、脑血管疾病（CVD）、肿瘤、外周动脉疾病（PAD）、痴呆和肝硬化（LC）。通过调整 Cox 回归分析评估每种合并症与全因死亡率的关系，该分析包括 13 种合并症、年龄、性别、巴氏指数、纽约心脏协会功能分级和 LVEF，并表示为调整后的风险比（HR）和 95%置信区间（95%CI）。
我们分析了 8336 名患者（82 岁；53%为女性；66%为 HFpEF）。平均随访时间为 1.0 年。与 HFrEF 相比，HFmrEF（HR：0.74；0.64-0.86）和 HFpEF（HR：0.75；0.68-0.84）的死亡率较低。考虑到所有患者，有 8 种合并症与死亡率相关：LC（HR：1.85；1.42-2.42）、HVD（HR：1.63；1.48-1.80）、CKD（HR：1.39；1.28-1.52）、PAD（HR：1.37；1.21-1.54）、肿瘤（HR：1.29；1.15-1.44）、DM（HR：1.26；1.15-1.37）、痴呆（HR：1.17；1.01-1.36）和 COPD（HR：1.17；1.06-1.29）。在三个 LVEF 亚组中，这些关联相似，LC、HVD、CKD 和 DM 在三个亚组中均具有显著意义。
HF 合并症与死亡率的相关性不同，LC 与死亡率的相关性最大。对于某些合并症，这种相关性根据 LVEF 可能有显著差异。
