Non-cardiac comorbidities in heart failure with reduced, mid-range and preserved ejection fraction

Abstract

Background: Comorbidities play a major role in heart failure. Whether prevalence and prognostic importance of comorbidities differ between heart failure with preserved ejection fraction (HFpEF), mid-range (HFmrEF) or reduced ejection fraction (HFrEF) is unknown. Methods: Patients from index (n = 2516) and validation cohort (n = 1738) of The BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) were pooled. Eight non-cardiac comorbidities were assessed; diabetes mellitus, thyroid dysfunction, obesity, anaemia, chronic kidney disease (CKD, estimated glomerular filtration rate b 60 mL/min/1.73 m 2 ), COPD, stroke and peripheral arterial disease. Patients were classified based on ejection fraction. The association of each comorbidity with quality of life (QoL), all-cause mortality and hospitalisation was evaluated. Results: Patients with complete comorbidity data were included (n = 3499). Most prevalent comorbidity was CKD (50%). All comorbidities showed the highest prevalence in HFpEF, except for stroke. Prevalences of HFmrEF were in between the other entities. COPD was the comorbidity associated with the greatest reduction in QoL. In HFrEF, almost all were associated with a significant reduction in QoL, while in HFpEF only CKD and obesity were associated with a reduction. Most comorbidities in HFrEF were associated with an increased mortality risk, while in HFpEF only CKD, anaemia and COPD were associated with higher mortality risks. Conclusions: The highest prevalence of comorbidities was seen in patients with HFpEF. Overall, comorbidities were associated with a lower QoL, but this was more pronounced in patients with HFrEF. Most comorbidities were associated with higher mortality risks, although the associations with diabetes were only present in patients with HFrEF.

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

“…The mortality risk of the comorbidities studied in both types of HF is similar, regardless of the EF [15][16][17]. Interestingly, in HFpEF, the incidence of hospitalisation for comorbidity-related illness is higher compared to HFrEF [18]. Table 1.…”

The role of sodium glucose cotransporter-2 (SGLT-2) inhibitors in heart failure and chronic kidney disease in type 2 diabetes

“…Another important distinction in patients with HF relates to the underlying cardiac function, usually defined by LV ejection fraction (LVEF). The traditional distinction is between HF with preserved ejection fraction (HFpEF; LVEF > 40%) and HF with reduced ejection fraction (HFrEF; LVEF 40%); some authorities recognize an intermediate form (HFmEF) with LVEF between 41-50% 33 . These conditions may have distinct natural histories and response to therapy 31 .…”

Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology ‐ Heart Failure Association EURObservational Research Programme Heart Failure Long‐Term Registry

“…[1][2][3][4] HFpEF is accompanied by multiple cardiovascular and non-cardiovascular comorbidities, potentially confusing the HFpEF diagnosis, as some of them present with symptoms that can mimic HF. [5][6][7][8][9] A growing understanding of the pathophysiology and clinical characteristics of HFpEF has resulted in proposals to identify a distinct clinical entity and attempts to develop specific diagnostic criteria. [1][2][3][4] Among these is the 2016 European Society of Cardiology (ESC) definition.…”