Association Between Cardiometabolic Comorbidity Burden and Outcomes in Heart Failure
Carine E Hamo1, Xiyue Li2, Chiadi E Ndumele3
1Leon H. Charney Division of Cardiology, Department of Medicine New York University School of Medicine New York NY.
Insights
Patients with heart failure (HF) and more severe cardiometabolic conditions like uncontrolled diabetes and hypertension face a higher risk of hospitalization. Managing these comorbidities is key to reducing HF morbidity.
Area of Science:
- Cardiology
- Metabolic Medicine
- Public Health
Background:
- Heart failure (HF) frequently co-occurs with cardiometabolic conditions such as obesity, diabetes, and hypertension.
- The prevalence of these comorbidities poses a significant challenge in managing HF patients.
Purpose of the Study:
- To investigate the association between the severity of cardiometabolic comorbidities and hospitalization rates in patients diagnosed with heart failure.
- To determine if a higher burden of uncontrolled cardiometabolic conditions correlates with increased hospital admissions for heart failure.
Main Methods:
- A retrospective analysis of electronic health records for adult patients (≥18 years) with HF.
- Patients were stratified based on the number of severe comorbidities: hypertension, diabetes, and obesity, defined by specific clinical thresholds (SBP ≥160 mmHg, HbA1c ≥8%, BMI ≥35 kg/m²).
- Cox regression models were employed to assess the risk of all-cause and HF-specific hospitalizations within one year, adjusting for various demographic and clinical factors. Analyses were stratified by HF type (preserved vs. reduced ejection fraction).
Main Results:
- The study included 26,800 HF patients, with 16% experiencing hospitalizations within one year.
- Individuals with one or two to three severely uncontrolled cardiometabolic comorbidities showed a significantly increased risk of all-cause hospitalization compared to those without comorbidities (HR 1.23 and 1.57, respectively).
- Similar associations were observed for heart failure hospitalizations, and these findings were consistent across HF with preserved and reduced ejection fraction subgroups.
Conclusions:
- An increased burden of severe cardiometabolic comorbidities is significantly associated with a higher risk of all-cause hospitalization in heart failure patients.
- These findings underscore the importance of aggressively managing and targeting uncontrolled cardiometabolic conditions to mitigate morbidity and reduce hospitalizations in the HF population.
Background:
Cardiometabolic comorbidities such as obesity, diabetes, and hypertension are highly prevalent in heart failure (HF). We aimed to examine the association between severity of cardiometabolic comorbidities and hospitalization in patients with HF.
Methods:
In a retrospective electronic health record-based cohort of adults 18 with HF, we categorized individuals based on the number of severe cardiometabolic comorbidities, including hypertension, diabetes, and obesity. Severely uncontrolled comorbidities were defined as systolic blood pressure ≥160 mm Hg, hemoglobin A1c ≥8%, and body mass index ≥35 kg/m2. Cox regression models were used to assess the association between cardiometabolic comorbidity burden and time to all-cause and HF hospitalization at 1 year, adjusting for age, sex, race or ethnicity, and insurance status, smoking, prior hospitalization, and Elixhauser comorbidity index. Stratified analyses were conducted for HF with preserved and reduced ejection fraction.
Results:
A total of 26 800 individuals with HF (mean age 7513.7, 46% women, 69% White) experienced 4284 (16%) hospitalizations over a 1-year period. Compared with individuals with absent comorbidities, those with 1 or 2 to 3 severely uncontrolled comorbidities had a significantly higher risk of all-cause hospitalization (hazard ratio [HR], 1.23 [95% CI, 1.09-1.39] and HR, 1.57 [95% CI, 1.35-1.83], respectively). We found similar associations for HF hospitalization. These associations were similar among individuals with HF with preserved ejection fraction compared with HF with reduced ejection fraction.
Conclusions:
Greater cardiometabolic comorbidity burden was associated with increased risk of all-cause hospitalization in HF. This reinforces the role for targeting severely uncontrolled cardiometabolic comorbidities to reduce morbidity in HF.
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