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Non-cardiac comorbidities and mortality in patients with heart failure with reduced vs. preserved ejection fraction: a study using the Swedish Heart Failure Registry
- Source :
- Clinical Research in Cardiology
- Publication Year :
- 2019
- Publisher :
- Linköpings universitet, Avdelningen för kardiovaskulär medicin, 2019.
-
Abstract
- Background Heart failure (HF) and non-cardiac comorbidities often coexist and are known to have an adverse effect on outcome. However, the prevalence and prognostic impact of non-cardiac comorbidities in patients with HF with reduced ejection fraction (HFrEF) vs. those with preserved (HFpEF) remain inadequately studied. Methods and results We used data from the Swedish Heart Failure Registry from 2000 to 2012. HFrEF was defined as EF amp;lt; 50% and HFpEF as EF amp;gt;= 50%. Of 31 344 patients available for analysis, 79.3% (n = 24 856) had HFrEF and 20.7% (n = 6 488) HFpEF. The outcome was all-cause mortality. We examined the association between ten non-cardiac comorbidities and mortality and its interaction with EF using adjusted hazard ratio (HR). Stroke, anemia, gout and cancer had a similar impact on mortality in both phenotypes, whereas diabetes (HR 1.57, 95% confidence interval [CI] [1.50-1.65] vs. HR 1.39 95% CI [1.27-1.51], p = 0.0002), renal failure (HR 1.65, 95% CI [1.57-1.73] vs. HR 1.44, 95% CI [1.32-1.57], p = 0.003) and liver disease (HR 2.13, 95% CI [1.83-2.47] vs. HR 1.42, 95% CI [1.09-1.85] p = 0.02) had a higher impact in the HFrEF patients. Moreover, pulmonary disease (HR 1.46, 95% CI [1.40-1.53] vs. HR 1.66 95% CI [1.54-1.80], p = 0.007) was more prominent in the HFpEF patients. Sleep apnea was not associated with worse prognosis in either group. No significant variation was found in the impact over the 12-year study period. Conclusions Non-cardiac comorbidities contribute significantly but differently to mortality, both in HFrEF and HFpEF. No significant variation was found in the impact over the 12-year study period. These results emphasize the importance of including the management of comorbidities as a part of a standardized heart failure care in both HF phenotypes. Funding Agencies|Swedish Heart-Lung Foundation [20170453]; Vastra Gotalands region [ALFGBG-721961]; University of Gothenburg [ALFGBG-721961]
- Subjects :
- Male
medicine.medical_specialty
Anemia
Comorbidity
030204 cardiovascular system & hematology
Comorbidities
03 medical and health sciences
0302 clinical medicine
Diabetes mellitus
Internal medicine
Prevalence
medicine
Humans
Cardiac and Cardiovascular Systems
Registries
030212 general & internal medicine
Mortality
Stroke
Aged
Aged, 80 and over
Heart Failure
Sweden
Original Paper
Ejection fraction
Kardiologi
business.industry
Hazard ratio
Sleep apnea
Stroke Volume
HFrEF
General Medicine
Middle Aged
Heart failure
HFpEF
Prognosis
medicine.disease
Confidence interval
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Clinical Research in Cardiology
- Accession number :
- edsair.doi.dedup.....36f01826822514fb76a48fc4f647d37c