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Non-cardiac comorbidities in HFrEF, HFmrEF and HFpEF - findings from BIOSTAT-CHF

Session Poster Session 2

Speaker Koen Streng

Event : Heart Failure 2017

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session

Authors : K W Streng (Groningen,NL), JF Nauta (Groningen,NL), JL Hillege (Groningen,NL), SD Anker (Gottingen,DE), JG Cleland (London,GB), CC Lang (Dundee,GB), M Metra (Brescia,IT), L Ng (Leicester,GB), P Ponikowski (Wroclaw,PL), DJ Van Veldhuisen (Groningen,NL), A Zwinderman (Amsterdam,NL), F Zannad (Nancy,FR), K Damman (Groningen,NL), P Van Der Meer (Groningen,NL), AA Voors (Groningen,NL)

Authors:
K W Streng1 , JF Nauta1 , JL Hillege1 , SD Anker2 , JG Cleland3 , CC Lang4 , M Metra5 , L Ng6 , P Ponikowski7 , DJ Van Veldhuisen1 , A Zwinderman8 , F Zannad9 , K Damman1 , P Van Der Meer1 , AA Voors1 , 1University Medical Center Groningen, Department of Cardiology - Groningen - Netherlands , 2University Medical Center Gottingen (UMG), Innovative Clinical Trials, Department of Cardiology and Pneumology - Gottingen - Germany , 3Imperial College London, National Heart & Lung Institute, Royal Brompton and Harefield Hospitals - London - United Kingdom , 4University of Dundee, School of Medicine Centre for Cardiovascular and Lung Biology - Dundee - United Kingdom , 5University of Brescia, Institute of Cardiology, Department of Medical and Surgical Specialties - Brescia - Italy , 6University of Leicester, Department of Cardiovascular Sciences - Leicester - United Kingdom , 7Wroclaw Medical University, Department of Heart Diseases - Wroclaw - Poland , 8Academic Medical Center of Amsterdam, Department of Epidemiology, Biostatistics and Bioinformatics - Amsterdam - Netherlands , 9University of Lorraine - Nancy - France ,

Citation:
European Journal of Heart Failure ( 2017 ) 19 ( Suppl. S1 ), 268

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 the index (n=2516) and validation cohort (n=1738) of The BIOlogy Study to Tailored Treatment in Chronic Heart Failure (BIOSTAT-CHF) were pooled for the present analysis. Seven non-cardiac comorbidities were assessed; diabetes mellitus, thyroid dysfunction, obesity, anaemia, chronic kidney disease (CKD), COPD and stroke. Patients were classified into 6 groups based on ejection fraction; HFrEF(<40%), HFmrEF (40-50%) and HFpEF (=50%), and having less or more than 3 comorbidities. Impact of each comorbidity on all-cause mortality was evaluated by population attributable risk (PAR).
Results: Patients with known LVEF and complete comorbidity data were included (n=3499). Most prevalent comorbidity was CKD, with a prevalence of 50%. All comorbidities had a higher prevalence in HFpEF, except for stroke. Patients with 3 or more comorbidities had higher all-cause mortality rates in HFrEF (hazard ratio (HR) 1.57, P<0.001) and HFmrEF (HR 1.39, P<0.001), but not in HFpEF (HR 1.02, P=0.902). Highest PARs were seen for CKD in all HF groups, whereas obesity has an inverse PAR in HFpEF. Diabetes and stroke contributed significantly in HFrEF (11% and 6%) but were not significant in HFpEF (-1% and 0%).
Conclusions: Overall, comorbidities are more prevalent in patients with HFpEF, but having more comorbidities is associated with an increased all-cause mortality in HFrEF and HFmrEF, but not in HFpEF. CKD has the highest impact on mortality in all groups. History of stroke and diabetes have a significant impact on all-cause mortality in HFrEF, in contrast to HFmrEF and HFpEF.

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