Non-cardiac comorbidities and mortality in patients with heart failure with reduced vs. preserved ejection fraction: a study using the Swedish Heart Failure Registry

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 < 50% and HFpEF as EF ≥ 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.

Cellular and Molecular Differences between HFpEF and HFrEF: A Step Ahead in an Improved Pathological Understanding

“…Additionally, men more easily develop eccentric left ventricular hypertrophy upon pressure-overload, while concentric hypertrophy is more common in females [13]. Patients with HFpEF have a higher prevalence of non-cardiac comorbidities (i.e., hypertension, T2DM, stroke, anaemia, pulmonary disease, liver disease, sleep apnoea, gout, and cancer) than HFrEF patients [14]. The mortality risk of the comorbidities studied in both types of HF is similar, regardless of the EF [15][16][17].…”

Therapeutic approaches in heart failure with preserved ejection fraction: past, present, and future

“…Clinical findings suggest that prognosis in patients with HFpEF is highly influenced by comorbidities [30][31][32]. This concept is addressed in the OPTIMIZE-HFpEF trial (NCT02425371).…”

Six-Month Predictive Value of Diuretic Resistance Formulas in Discharged Heart Failure Patients after an Acute Decompensation

“…This result seemed to be correlated to the worst renal function of HFrEF patients in comparison with HFpEF ( p = 0.001 for creatinine and eGFR). The diuretic response has been demonstrated to be strictly correlated to renal impairment [ 16 , 23 ] and it has been shown that HFpEF had a better renal function in comparison to HFrEF [ 29 ]. In our clinical experience we demonstrated as the response to loop diuretic in HFrEF patients, measured with DR or R-to-D, was impaired in comparison to HFpEF, adding to our knowledge of the differences between the two different HF syndromes.…”