Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction

Sameer Ather, Wenyaw Chan, Biykem Bozkurt, David Aguilar, Kumudha Ramasubbu, Amit A. Zachariah, Xander H.T. Wehrens, Anita Deswal

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559 Scopus citations

Abstract

Objectives: The aim of this study was to evaluate the prevalence and prognostic impacts of noncardiac comorbidities in patients with heart failure (HF) with preserved ejection fraction (HFpEF) compared with those with HF with reduced ejection fraction (HFrEF). Background: There is a paucity of information on the comparative prognostic significance of comorbidities between patients with HFpEF and those with HFrEF. Methods: In a national ambulatory cohort of veterans with HF, the comorbidity burden of 15 noncardiac comorbidities and the impacts of these comorbidities on hospitalization and mortality were compared between patients with HFpEF and those with HFrEF. Results: The cohort consisted of 2,843 patients with HFpEF and 6,599 with HFrEF with 2-year follow-up. Compared with patients with HFrEF, those with HFpEF were older and had higher prevalence of chronic obstructive pulmonary disease, diabetes, hypertension, psychiatric disorders, anemia, obesity, peptic ulcer disease, and cancer but a lower prevalence of chronic kidney disease. Patients with HFpEF had lower HF hospitalization, higher non-HF hospitalization, and similar overall hospitalization compared with those with HFrEF (p < 0.001, p < 0.001, and p = 0.19, respectively). An Increasing number of noncardiac comorbidities was associated with a higher risk for all-cause admissions (p < 0.001). Comorbidities had similar impacts on mortality in patients with HFpEF compared with those with HFrEF, except for chronic obstructive pulmonary disease, which was associated with a higher hazard (1.62 [95% confidence interval: 1.36 to 1.92] vs. 1.23 [95% confidence interval: 1.11 to 1.37], respectively, p = 0.01 for interaction) in patients with HFpEF. Conclusions: There is a higher noncardiac comorbidity burden associated with higher non-HF hospitalizations in patients with HFpEF compared with those with HFrEF. However, individually, most comorbidities have similar impacts on mortality in both groups. Aggressive management of comorbidities may have an overall greater prognostic impact in HFpEF compared to HFrEF.

Original languageEnglish
Pages (from-to)998-1005
Number of pages8
JournalJournal of the American College of Cardiology
Volume59
Issue number11
DOIs
StatePublished - Mar 13 2012

Bibliographical note

Funding Information:
This study was supported in part by VA Health Services Research & Development Service grant IIR 02-082-1 to Dr. Deswal. Dr. Ather is supported by an American Heart Association predoctoral fellowship (2010–2012) and an Alkek Foundation fellowship (2009–2012). Dr. Bozhurt has received a research grant from Forest Pharmaceuticals . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Keywords

  • comorbidities
  • diastolic heart function
  • heart failure with preserved ejection fraction
  • heart failure with reduced ejection fraction
  • prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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