Non-cardiac Comorbidities in Heart Failure with Reduced, Mid-range and Preserved Ejection Fraction

Koen W. Streng, Jan F. Nauta, Hans L. Hillege, Stefan D. Anker, John G. F. Cleland, Kenneth Dickstein, Gerasimos S. Filippatos, Chim Lang, Marco Metra, Leong Ng, Piotr Ponikowski, Nilesh J. Samani, Dirk J. van Veldhuisen, Aeilko H. Zwinderman, Faiez Zannad, Kevin Damman, Peter van der Meer, Adriaan A. Voors (Lead / Corresponding author)

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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 <60 mL/min/1.73m2), 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 was only present in patients with HFrEF.
Original languageEnglish
Pages (from-to)132-139
Number of pages8
JournalInternational journal of cardiology
Volume271
Early online date7 Jul 2018
DOIs
Publication statusPublished - 15 Nov 2018

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Comorbidity
Heart Failure
Quality of Life
Chronic Obstructive Pulmonary Disease
Mortality
Anemia
Obesity
Stroke
Peripheral Arterial Disease
Glomerular Filtration Rate
Chronic Renal Insufficiency
Diabetes Mellitus
Thyroid Gland
Hospitalization

Keywords

  • CKD
  • Comorbidities
  • Heart failure
  • Mortality
  • Quality of life

Cite this

Streng, K. W., Nauta, J. F., Hillege, H. L., Anker, S. D., Cleland, J. G. F., Dickstein, K., ... Voors, A. A. (2018). Non-cardiac Comorbidities in Heart Failure with Reduced, Mid-range and Preserved Ejection Fraction. International journal of cardiology, 271, 132-139. https://doi.org/10.1016/j.ijcard.2018.04.001
Streng, Koen W. ; Nauta, Jan F. ; Hillege, Hans L. ; Anker, Stefan D. ; Cleland, John G. F. ; Dickstein, Kenneth ; Filippatos, Gerasimos S. ; Lang, Chim ; Metra, Marco ; Ng, Leong ; Ponikowski, Piotr ; Samani, Nilesh J. ; van Veldhuisen, Dirk J. ; Zwinderman, Aeilko H. ; Zannad, Faiez ; Damman, Kevin ; van der Meer, Peter ; Voors, Adriaan A. / Non-cardiac Comorbidities in Heart Failure with Reduced, Mid-range and Preserved Ejection Fraction. In: International journal of cardiology. 2018 ; Vol. 271. pp. 132-139.
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title = "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 <60 mL/min/1.73m2), 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 was only present in patients with HFrEF.",
keywords = "CKD, Comorbidities, Heart failure, Mortality, Quality of life",
author = "Streng, {Koen W.} and Nauta, {Jan F.} and Hillege, {Hans L.} and Anker, {Stefan D.} and Cleland, {John G. F.} and Kenneth Dickstein and Filippatos, {Gerasimos S.} and Chim Lang and Marco Metra and Leong Ng and Piotr Ponikowski and Samani, {Nilesh J.} and {van Veldhuisen}, {Dirk J.} and Zwinderman, {Aeilko H.} and Faiez Zannad and Kevin Damman and {van der Meer}, Peter and Voors, {Adriaan A.}",
note = "This work was supported by the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation [CVON2014-11 RECONNECT] and a grant from the European Commission [FP7-242209-BIOSTAT-CHF; EudraCT 2010–020808–29].",
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Streng, KW, Nauta, JF, Hillege, HL, Anker, SD, Cleland, JGF, Dickstein, K, Filippatos, GS, Lang, C, Metra, M, Ng, L, Ponikowski, P, Samani, NJ, van Veldhuisen, DJ, Zwinderman, AH, Zannad, F, Damman, K, van der Meer, P & Voors, AA 2018, 'Non-cardiac Comorbidities in Heart Failure with Reduced, Mid-range and Preserved Ejection Fraction', International journal of cardiology, vol. 271, pp. 132-139. https://doi.org/10.1016/j.ijcard.2018.04.001

Non-cardiac Comorbidities in Heart Failure with Reduced, Mid-range and Preserved Ejection Fraction. / Streng, Koen W.; Nauta, Jan F.; Hillege, Hans L.; Anker, Stefan D.; Cleland, John G. F.; Dickstein, Kenneth; Filippatos, Gerasimos S.; Lang, Chim; Metra, Marco; Ng, Leong; Ponikowski, Piotr; Samani, Nilesh J.; van Veldhuisen, Dirk J.; Zwinderman, Aeilko H.; Zannad, Faiez; Damman, Kevin; van der Meer, Peter; Voors, Adriaan A. (Lead / Corresponding author).

In: International journal of cardiology, Vol. 271, 15.11.2018, p. 132-139.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Non-cardiac Comorbidities in Heart Failure with Reduced, Mid-range and Preserved Ejection Fraction

AU - Streng, Koen W.

AU - Nauta, Jan F.

AU - Hillege, Hans L.

AU - Anker, Stefan D.

AU - Cleland, John G. F.

AU - Dickstein, Kenneth

AU - Filippatos, Gerasimos S.

AU - Lang, Chim

AU - Metra, Marco

AU - Ng, Leong

AU - Ponikowski, Piotr

AU - Samani, Nilesh J.

AU - van Veldhuisen, Dirk J.

AU - Zwinderman, Aeilko H.

AU - Zannad, Faiez

AU - Damman, Kevin

AU - van der Meer, Peter

AU - Voors, Adriaan A.

N1 - This work was supported by the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation [CVON2014-11 RECONNECT] and a grant from the European Commission [FP7-242209-BIOSTAT-CHF; EudraCT 2010–020808–29].

PY - 2018/11/15

Y1 - 2018/11/15

N2 - 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 <60 mL/min/1.73m2), 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 was only present in patients with HFrEF.

AB - 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 <60 mL/min/1.73m2), 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 was only present in patients with HFrEF.

KW - CKD

KW - Comorbidities

KW - Heart failure

KW - Mortality

KW - Quality of life

U2 - 10.1016/j.ijcard.2018.04.001

DO - 10.1016/j.ijcard.2018.04.001

M3 - Article

C2 - 30482453

VL - 271

SP - 132

EP - 139

JO - International journal of cardiology

JF - International journal of cardiology

SN - 0167-5273

ER -