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Association of Charlson Comorbidity Index with Clinical Characteristics and Outcomes in Heart Failure
Naba Farooqui1, Lina Benson2, Tonje Thorvaldsen2,3
1Department of Internal Medicine Mayo Clinic, Rochester MN, USA.
Insights
The age-adjusted Charlson Comorbidity Index (ACCI) effectively predicts outcomes in heart failure (HF). Higher ACCI scores correlate with increased HF severity, reduced guideline-directed medical therapy (GDMT) use, and worse quality of life, indicating its prognostic value.
Area of Science:
- Cardiology
- Geriatric Medicine
- Public Health
Background:
- The Charlson Comorbidity Index (CCI) is a standard measure of comorbidity burden.
- Its specific role and impact in heart failure (HF) patients remain unclear.
- The age-adjusted CCI (ACCI) offers a refined assessment of comorbidity in diverse populations.
Purpose of the Study:
- To evaluate the age-adjusted Charlson Comorbidity Index (ACCI) in a large heart failure (HF) cohort.
- To determine the association between ACCI and guideline-directed medical therapy (GDMT) utilization.
- To investigate the relationship between ACCI and HF patient outcomes, including mortality and hospitalizations.
Main Methods:
- Analysis of the Swedish Heart Failure Registry (SwedeHF) including 117,419 patients.
- Stratification of patients into low, intermediate, and high ACCI score groups (1-3, 4-6, ≥7).
- Utilized multivariable multinomial and Cox regression models to assess associations with clinical characteristics, GDMT, ejection fraction (EF) categories, and 3-year outcomes.
Main Results:
- Higher ACCI scores were associated with increased HF severity (higher EF category, NYHA class, NT-proBNP, diuretic use) and reduced quality of life.
- Patients with higher ACCI scores demonstrated lower utilization of guideline-directed medical therapy (GDMT).
- Elevated ACCI significantly increased the risk of composite cardiovascular (CV) mortality/HF hospitalization, non-CV mortality, CV mortality, and total/HF hospitalizations.
Conclusions:
- The ACCI is a valuable tool for risk stratification in heart failure (HF) patients.
- Higher ACCI scores are linked to greater HF severity, decreased GDMT use, and poorer quality of life.
- ACCI strongly predicts mortality (both CV and non-CV) and hospitalizations in HF, with a more pronounced association with death than hospitalization.
Background:
The Charlson comorbidity index (CCI) is a validated weighted measure of comorbidity burden, but has an unclear role in heart failure (HF).
Objectives:
To characterize age-adjusted CCI (ACCI) in HF, its association with the use of guideline-directed medical therapy (GDMT) and with outcomes.
Methods:
In the Swedish HF registry, patients were divided into 3 groups based on ACCI scores (low 1-3, intermediate 4-6, and high ≥7). We studied its association with clinical characteristics and GDMT use. Multivariable multinominal and Cox regressions were used to analyze ACCI and its association with ejection fraction (EF) category (reduced [HFrEF], mildly reduced [HFmrEF], preserved [HFpEF]), and with outcomes up to 3 years.
Results:
Among 117,419 patients (age 75 [66-82], 36% women, 53% HFrEF, 24% HFmrEF, 23% HFpEF, median ACCI was 5, 6 and 6 respectively. ACCI ≥7 was present in 31% with HFrEF, 35% with HFmrEF and 42% with HFpEF. A higher ACCI score was associated with higher EF category, NYHA class, serum NT-proBNP, diuretic use, and lower quality of life and GDMT use (p<0.05 for all). The risk of composite CV mortality/first HF hospitalization was higher with intermediate (adjusted HR 1.34, 95% CI 1.29-1.39) and high vs low ACCI (1.76, 1.69-1.83). High ACCI category (vs low) was significantly associated with non-CV (adjusted HR 6.36, 95% CI 5.75-7.04), but also, CV mortality (4.35, 3.99-4.74), and total hospitalizations (adjusted IRR 2.16, 2.11-2.22) but also HF hospitalizations 1.23 (1.17-1.28).
Conclusion:
The ACCI discriminates well in HF, with higher ACCI being associated with greater severity of HF, lesser GDMT use and worse quality of life. Higher ACCI was more strongly associated with death than hospitalization. Higher ACCI was more strongly associated with non-CV outcomes but also with CV and HF outcomes.
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