Impact of multimorbidity on mortality in heart failure with reduced ejection fraction: which comorbidities matter most? An analysis of <scp>PARADIGM‐HF</scp> and <scp>ATMOSPHERE</scp>

Dewan, Pooja; Ferreira, João Pedro; Butt, Jawad H; Petrie, Mark C.; Abraham, William T.; Desai, Akshay S.; Dickstein, Kenneth; Kober, L; Packer, Milton; Rouleau, Jean L.; Stewart, S. Evelyn; Swedberg, Karl; Zile, Michael R.; Solomon, Scott D.; Jhund, Pardeep S.; McMurray, John J.

doi:10.1002/ejhf.2856

Cited by 5 publications

(8 citation statements)

References 42 publications

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“…Our results are consistent with a recent pooled analysis of the PARADIGM‐HF and the ATMOSPHERE trials including 15 066 patients and showing that >93% of HFrEF patients had at least one comorbidity and 79% had at least two comorbidities 7 . In our study we found that about 98% of HF patients had at least one comorbidity (94% had at least one CV comorbidity and 85% had at least one non‐CV comorbidity).…”

Section: Discussionsupporting

confidence: 93%

“…The most common comorbidities were hypertension (65%), atrial fibrillation (56%) and CAD (52%), followed by CKD (40%) and anaemia (34%). Results are consistent with those in the PARADIGM‐HF and ATMOSPHERE trials 7 . On the other hand, we found a significantly higher prevalence of atrial fibrillation (ranging from 51% to 66% in patients with HFrEF and HFpEF, respectively) compared to the previously motioned analyses from trials (24–36%).…”

Section: Discussionsupporting

confidence: 90%

“…A large proportion of patients with HF have coexisting cardiovascular (CV) and non‐CV comorbid conditions. Comorbidities have been recognized as an important contributor to patients' frailty status, quality of life and prognosis, 2–8 and lead to the need of polypharmacy 1,9 …”

Section: Introductionmentioning

confidence: 99%

“…Several studies explored the prevalence of CV and non‐CV comorbidities and their association with outcomes and health status using data from major randomized clinical trials 7,8,10 . However, patients with comorbidities are often under‐represented in clinical trials due to enrolment criteria, safety aspects, e.g.…”

Section: Introductionmentioning

confidence: 99%

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The role of multimorbidity in patients with heart failure across the left ventricular ejection fraction spectrum: Data from the Swedish Heart Failure Registry

Tomasoni,

Vitale,

Guidetti

et al. 2024

European J of Heart Fail

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AimsThe aim of this analysis was to provide data on the overall comorbidity burden, both cardiovascular (CV) and non‐CV, in a large real‐world heart failure (HF) population across the ejection fraction (EF).Methods and ResultsPatients with HF from the Swedish HF Registry between 2000‐2021 were included. Of 91,463 patients (median age 76 years [IQR 67–82]), 98% had at least one among the 17 explored comorbidities (94% at least one CV and 85% at least one non‐CV comorbidity). All comorbidities, except for coronary artery disease (CAD), were more frequent in HF with preserved EF (HFpEF). Patients with multiple comorbidities were older, more likely female, inpatients, with HFpEF, worse NYHA class and higher NT‐proBNP levels. In a multivariable Cox model, 12 comorbidities were independently associated with a higher risk of death from any cause. The highest risk was associated with dementia (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.45‐1.65), chronic kidney disease (HR 1.37, 95%CI 1.34‐1.41), chronic obstructive pulmonary disease (HR 1.32, 95%CI 1.28‐1.35). Obesity was associated with a lower risk of all‐cause death (HR 0.81, 95%CI 0.79‐0.84). CAD and valvular heart disease were associated with a higher risk of all‐cause and CV mortality, but not non‐CV mortality, whereas cancer and muscolo‐skeletal disease increased the risk of non‐CV mortality. A significant interaction with EF was observed for several comorbidities. Occurrence of CV and non‐CV outcomes was related to the number of CV and non‐CV comorbidities, respectively.ConclusionThe burden of both CV and non‐CV comorbidities was high in HF regardless of EF, but overall higher in HFpEF. Multimorbidity was associated with a high risk of death with a different burden on CV or non‐CV outcomes.This article is protected by copyright. All rights reserved.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The role of multimorbidity in patients with heart failure across the left ventricular ejection fraction spectrum: Data from the Swedish Heart Failure Registry

Tomasoni,

Vitale,

Guidetti

et al. 2024

European J of Heart Fail

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“…Consistent with the findings of other studies, CV comorbidities such as hypertension, atrial fibrillation, coronary artery disease were more prevalent in HF patients 8 while mental and behavioural diseases such as depression and dementia were less prevalent across the HF spectrum studied. Obesity was associated with reduced mortality but increased hospitalizations across the HF spectrum.…”

supporting

confidence: 91%

Multimorbidity in the era of increasing life expectancy and aging population

Patel,

Yeboah

2024

European J of Heart Fail

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This article refers to 'The role of multimorbidity in patients with heart failure across the left ventricular ejection fraction spectrum: Data from the Swedish Heart Failure Registry' by D. Tomasoni et al., published in this issue on pages 854-868.The global prevalence of heart failure (HF) is estimated as 1-3%. 1 While the prevalence of HF with reduced ejection fraction (HFrEF) worldwide is levelling off due to a reducing incidence, the prevalence of HF with preserved ejection fraction (HFpEF) is increasing. HF mortality remains high with an estimated 5-year rate of over 50% worldwide. The annual healthcare cost for HF is estimated at about € 25 500 per year, driven mostly by direct cost but also by other factors including the rise in non-cardiovascular (CV) comorbidities especially in HFpEF. 1 . It should be emphasized that this increased prevalence of comorbidities and its associated cost, is not unique to HF but also seen in other chronic diseases. 2 The intersection between an aging population and HF has become increasingly complex due to multimorbidity (two or more comorbidities). The prevalence of multimorbidity in HF patients is estimated at 43-98% and varies widely depending on geographical region. 3 Multimorbidity portends increased HF hospitalization and mortality in both HFrEF and HFpEF. 3 Despite advances in pharmacologic and non-pharmacologic treatment modalities, multimorbidity has made management of HF challenging and has reduced the projected benefits of these therapies.Current guidelines have emphasized the importance of early implementation of guideline-directed medical therapy (GDMT) in patients with HF to reduce morbidity and mortality, particularly in patients with HFrEF. 4,5 An important observation in registry data is the decreased prescription of GDMT in multimorbid HF patients, who are often sicker and frailer with greater intolerance to GDMT due to increased drug-drug interactions and side effects. For the practicing clinician, there is often a reluctance to contribute to polypharmacy in a multimorbid HF patient even if the drug is recommended by guidelines as part of GDMT. The presence of some comorbidities such as mentalThe opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

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2024 update in heart failure

Beghini,

Sammartino,

Papp

et al. 2024

ESC Heart Failure

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In the last years, major progress has occurred in heart failure (HF) management. The 2023 ESC focused update of the 2021 HF guidelines introduced new key recommendations based on the results of the last years of science. First, two drugs, sodium–glucose co‐transporter‐2 (SGLT2) inhibitors and finerenone, a novel nonsteroidal, selective mineralocorticoid receptor antagonist (MRA), are recommended for the prevention of HF in patients with diabetic chronic kidney disease (CKD). Second, SGLT2 inhibitors are now recommended for the treatment of HF across the entire left ventricular ejection fraction spectrum. The benefits of quadruple therapy in patients with HF with reduced ejection fraction (HFrEF) are well established. Its rapid and early up‐titration along with a close follow‐up with frequent clinical and laboratory re‐assessment after an episode of acute HF (the so‐called ‘high‐intensity care’ strategy) was associated with better outcomes in the STRONG‐HF trial. Patients experiencing an episode of worsening HF might require a fifth drug, vericiguat. In the STEP‐HFpEF‐DM and STEP‐HFpEF trials, semaglutide 2.4 mg once weekly administered for 1 year decreased body weight and significantly improved quality of life and the 6 min walk distance in obese patients with HF with preserved ejection fraction (HFpEF) with or without a history of diabetes. Further data on safety and efficacy, including also hard endpoints, are needed to support the addition of acetazolamide or hydrochlorothiazide to a standard diuretic regimen in patients hospitalized due to acute HF. In the meantime, PUSH‐AHF supported the use of natriuresis‐guided diuretic therapy. Further options and most recent evidence for the treatment of HF, including specific drugs for cardiomyopathies (i.e., mavacamten in hypertrophic cardiomyopathy and tafamidis in transthyretin cardiac amyloidosis), device therapies, cardiac contractility modulation and percutaneous treatment of valvulopathies, with the recent finding from the TRILUMINATE Pivotal trial, are also reviewed in this article.

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Impact of multimorbidity on mortality in heart failure with reduced ejection fraction: which comorbidities matter most? An analysis of PARADIGM‐HF and ATMOSPHERE

Cited by 5 publications

References 42 publications

The role of multimorbidity in patients with heart failure across the left ventricular ejection fraction spectrum: Data from the Swedish Heart Failure Registry

The role of multimorbidity in patients with heart failure across the left ventricular ejection fraction spectrum: Data from the Swedish Heart Failure Registry

Multimorbidity in the era of increasing life expectancy and aging population

2024 update in heart failure

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