Even a Low Comorbidity Burden Predicts Poor Outcomes in Chronic Heart Failure
Catarina Elias1,2, Ana Neves1,2, Rita Gouveia1,2
1From the Serviço de Medicina Interna do Centro Hospitalar e Universitário de São João, Porto, Portugal.
Insights
Multiple cardiovascular risk factors (CVRFs) and comorbidities (CMBs) significantly increase heart failure mortality. Assessing CVRFs and CMBs is crucial for managing heart failure patients and improving prognosis.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Heart failure patients frequently present with multiple cardiovascular risk factors (CVRFs) and comorbidities (CMBs).
- The cumulative impact of these conditions on heart failure prognosis requires further evaluation.
Purpose of the Study:
- To assess the prognostic impact of additive cardiovascular risk factors and comorbidities in patients with systolic dysfunction.
- To determine if an increased burden of CVRFs and CMBs independently affects all-cause mortality.
Main Methods:
- Retrospective analysis of ambulatory patients with systolic dysfunction (Jan 2012 - May 2018).
- Follow-up until Jan 2021, with all-cause death as the primary endpoint.
- CVRFs included hypertension, diabetes, smoking; CMBs included various chronic conditions and atrial fibrillation. Patients were classified by the number of CVRFs/CMBs (<2 and ≥2).
Main Results:
- A significant proportion of patients had multiple comorbidities (67.9%).
- Mortality was higher in patients with ≥2 CVRFs (56.1%) and ≥2 CMBs (57.7%) compared to those with fewer.
- Patients with ≥2 CVRFs/CMBs faced a more than doubled risk of dying (adjusted HR, 2.20).
Conclusions:
- The presence of two or more cardiovascular risk factors or comorbidities significantly elevates mortality risk in heart failure patients.
- Routine assessment of CVRFs and CMBs is recommended for comprehensive patient management and improved outcomes.
Background:
Patients with heart failure often have multiple cardiovascular risk factors (CVRFs) and comorbidities (CMBs). We evaluated the impact of additive CMB and CVRF on heart failure prognosis.
Methods:
We retrospectively analyzed ambulatory patients with systolic dysfunction between January 2012 and May 2018. Follow-up was until January 2021. The endpoint was all-cause death. CVRF analyzed arterial hypertension, diabetes mellitus, and smoking. CMB evaluated coronary artery disease, noncoronary atherosclerotic disease, respiratory disease, dementia, anemia, chronic kidney disease, inflammatory/autoimmune disease, active cancer, and atrial fibrillation. Classification according to the number of CVRFs and/or CMBs is <2 and ≥2. The independent prognostic impact of CVRF/CMB burden was assessed with multivariate Cox regression.
Results:
Most patients had ≥2 CMBs (67.9%). Regarding CVRF, 14.9% presented none, 40.2% had 1, and 32.1% had 2. During a median 49-month follow-up, 419 (49.1%) patients died. Mortality was higher among patients with ≥2 CVRFs (56.1 versus 43.4% in those with <2) and in those with ≥2 CMBs (57.7 versus 31.0%). While patients with 1 CMB had similar mortality than those with none. Patients with ≥2 CMBs had higher long-term mortality risk: hazard ratio (HR), 2.47 (95% CI, 1.95-3.14). In patients with ≥2CVRFs, the HR of dying is 1.39 (95% CI, 1.14-1.70). When taken together, there was a clear survival disadvantage for patients with ≥2 CVRFs/CMBs-adjusted HR, 2.20 (95% CI, 1.45-3.34).
Conclusions:
The presence of only 2 CVRFs/CMBs more than doubles the patients´ risk of dying. CVRF and CMB should be assessed as part of routine patient management.
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