Cardiovascular Research Institute and the Department of Medicine, Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany; Berlin Institute of Health, Berlin, Germany; DZHK German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany.
Fifth Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Lancet Glob Health. 2023 Dec;11(12):e1874-e1884. doi: 10.1016/S2214-109X(23)00408-4.
Multimorbidity (two or more comorbidities) is common among patients with acute heart failure, but comprehensive global information on its prevalence and clinical consequences across different world regions and income levels is scarce. This study aimed to investigate the prevalence of multimorbidity and its effect on pharmacotherapy and prognosis in participants of the REPORT-HF study.
REPORT-HF was a prospective, multicentre, global cohort study that enrolled adults (aged ≥18 years) admitted to hospital with a primary diagnosis of acute heart failure from 358 hospitals in 44 countries on six continents. Patients who currently or recently participated in a clinical treatment trial were excluded. Follow-up data were collected at 1-year post-discharge. The primary outcome was 1-year post-discharge mortality. All patients in the REPORT-HF cohort with full data on comorbidities were eligible for the present study. We stratified patients according to the number of comorbidities, and countries by world region and country income level. We used one-way ANOVA, χ test, or Mann-Whitney U test for comparisons between groups, as applicable, and Cox regression to analyse the association between multimorbidity and 1-year mortality.
Between July 23, 2014, and March 24, 2017, 18 553 patients were included in the REPORT-HF study. Of these, 18 528 patients had full data on comorbidities, of whom 11 360 (61%) were men and 7168 (39%) were women. Prevalence rates of multimorbidity were lowest in southeast Asia (72%) and highest in North America (92%). Fewer patients from lower-middle-income countries had multimorbidity than patients from high-income countries (73% vs 85%, p<0·0001). With increasing comorbidity burden, patients received fewer guideline-directed heart failure medications, yet more drugs potentially causing or worsening heart failure. Having more comorbidities was associated with worse outcomes: 1-year mortality increased from 13% (no comorbidities) to 26% (five or more comorbidities). This finding was independent of common baseline risk factors, including age and sex. The population-attributable fraction of multimorbidity for mortality was higher in high-income countries than in upper-middle-income or lower-middle-income countries (for patients with five or more comorbidities: 61% vs 27% and 31%, respectively).
Multimorbidity is highly prevalent among patients with acute heart failure across world regions, especially in high-income countries, and is associated with higher mortality, less prescription of guideline-directed heart failure pharmacotherapy, and increased use of potentially harmful medications.
Novartis Pharma.
For the Arabic, French, German, Hindi, Mandarin, Russian and Spanish translations of the abstract see Supplementary Materials section.
多种合并症（两种或更多种合并症）在急性心力衰竭患者中很常见，但关于其在不同世界区域和收入水平的患病率及其临床后果的综合全球信息却很少。本研究旨在调查 REPORT-HF 研究中患者多种合并症的患病率及其对药物治疗和预后的影响。
REPORT-HF 是一项前瞻性、多中心、全球性队列研究，纳入了来自六大洲 44 个国家 358 家医院因急性心力衰竭初次住院的成年患者（年龄≥18 岁）。目前或最近参加过临床治疗试验的患者被排除在外。出院后 1 年时收集随访数据。主要结局为出院后 1 年的死亡率。REPORT-HF 队列中所有有完整合并症数据的患者均符合本研究条件。我们根据合并症的数量对患者进行分层，根据世界区域和国家收入水平对国家进行分层。组间比较采用单因素方差分析、χ2 检验或曼-惠特尼 U 检验，cox 回归分析多种合并症与 1 年死亡率之间的关系。
2014 年 7 月 23 日至 2017 年 3 月 24 日，REPORT-HF 研究共纳入 18553 例患者。其中，18528 例患者有完整的合并症数据，其中 11360 例（61%）为男性，7168 例（39%）为女性。东南亚的多种合并症患病率最低（72%），北美最高（92%）。中低收入国家的患者合并症患病率低于高收入国家（73%比 85%，p<0·0001）。随着合并症负担的增加，患者接受的指南指导的心力衰竭药物治疗减少，但潜在导致或加重心力衰竭的药物治疗增加。合并症越多，预后越差：1 年死亡率从无合并症（13%）增加到有 5 种或更多合并症（26%）。这一发现独立于常见的基线风险因素，包括年龄和性别。高收入国家多种合并症对死亡率的人群归因分数高于中高收入国家或中低收入国家（对于有 5 种或更多合并症的患者：分别为 61%、27%和 31%）。
多种合并症在世界各地的急性心力衰竭患者中患病率很高，尤其是在高收入国家，且与死亡率升高、指南指导的心力衰竭药物治疗处方减少以及潜在有害药物使用增加有关。
诺华制药。
