Department of Cardiology, University Medical Centre Groningen, University of Groningen, the Netherlands.
Department of Cardiology, University Medical Centre Groningen, University of Groningen, the Netherlands; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Duke-NUS Medical School, Singapore.
JACC Heart Fail. 2024 Oct;12(10):1762-1774. doi: 10.1016/j.jchf.2024.04.028. Epub 2024 Jul 3.
Multimorbidity frequently occurs in patients with acute heart failure (AHF). The co-occurrence of comorbidities often follows specific patterns.
This study investigated multimorbidity subtypes and their associations with clinical outcomes.
From the prospective RELAX-AHF-2 (Relaxin for the Treatment of Acute Heart Failure-2) trial, 6,545 patients (26% with HF with preserved ejection fraction, defined as LVEF ≥50%) were classified into multimorbidity groups using latent class analysis. The association between subgroups and clinical outcomes was examined. Validation of these findings was conducted in the RELAX-AHF trial, which comprised 1,161 patients.
Five distinct multimorbidity groups emerged: 1) diabetes and chronic kidney disease (CKD) (often male, high prevalence of CKD and diabetes mellitus); 2) ischemic (ischemic HF); 3) elderly/atrial fibrillation (AF) (oldest, high prevalence of AF); 4) metabolic (obese, hypertensive, more often HF with preserved ejection fraction); and 5) young (fewest comorbidities). After adjusting for confounders, patients in the diabetes and CKD (HR: 1.80; 95% CI: 1.50-2.20), elderly/AF (HR: 1.42; 95% CI: 1.20-1.70), and metabolic (HR: 1.40; 95% CI: 1.20-1.80) groups had higher rates of the composite outcome than patients in the young group, primarily driven by differences in rehospitalization. Treatment allocation (placebo or serelaxin) modified these associations (P <0.001). Serelaxin-treated patients in the young group were associated with a lower risk for all-cause mortality (HR: 0.59; 95% CI: 0.40-0.90). Similarly, patients from the RELAX-AHF trial clustered in 5 multimorbidity groups. The clinical characteristics and associations with outcomes could also be validated.
Comorbidities naturally clustered into 5 mutually exclusive groups in RELAX-AHF-2, showing variations in clinical outcomes. These data emphasize that the specific combination of comorbidities can influence adverse outcomes and treatment responses in patients with AHF.
急性心力衰竭（AHF）患者常同时患有多种疾病。合并症的同时发生通常遵循特定模式。
本研究旨在探讨多种疾病亚型及其与临床结局的关系。
来自前瞻性 RELAX-AHF-2（松弛素治疗急性心力衰竭-2）试验的 6545 名患者（26%为射血分数保留的心力衰竭，定义为 LVEF≥50%）采用潜在类别分析分为多种疾病组。研究分析了亚组与临床结局之间的关系。在 RELAX-AHF 试验中对这些发现进行了验证，该试验纳入了 1161 名患者。
共出现 5 种不同的多种疾病组：1）糖尿病和慢性肾脏病（CKD）（通常为男性，CKD 和糖尿病患病率高）；2）缺血性（缺血性心力衰竭）；3）老年/心房颤动（AF）（最年长，AF 患病率高）；4）代谢性（肥胖、高血压，更常为射血分数保留的心力衰竭）；5）年轻（合并症最少）。调整混杂因素后，与年轻组相比，糖尿病和 CKD 组（HR：1.80；95%CI：1.50-2.20）、老年/AF 组（HR：1.42；95%CI：1.20-1.70）和代谢组（HR：1.40；95%CI：1.20-1.80）患者的复合结局发生率更高，主要是由于住院率的差异。治疗分配（安慰剂或 serelaxin）改变了这些关联（P<0.001）。年轻组中接受 serelaxin 治疗的患者全因死亡率风险降低（HR：0.59；95%CI：0.40-0.90）。同样，RELAX-AHF 试验中的患者也聚类为 5 种多种疾病组。临床特征和结局相关性也得到验证。
RELAX-AHF-2 中的合并症自然聚类为 5 个相互排斥的组，显示出不同的临床结局。这些数据强调了 AHF 患者特定的合并症组合可以影响不良结局和治疗反应。
