Prognostic impact of comorbidities in hospitalized patients with acute exacerbation of chronic heart failure

• DOI: 10.1016/j.ejim.2016.05.020
• Publication Date: 2016-06-02T14:39:52Z
• Authors: Domenico Scrutinio; Andrea Passantino; Pietro Guida; Enrico Ammirati; Fabrizio Oliva; Simona Sarzi Braga; Maria Teresa La R...; Rocco Lagioia; Maria Frigerio
• Keywords: Male; Comorbidity; Coronary Artery Disease; Kaplan-Meier Estimate; End Stage Liver Disease; 03 medical and health sciences; 0302 clinical medicine; Atrial Fibrillation; Natriuretic Peptide, Brain; Humans; Obesity; Aged; Aged, 80 and over; Heart Failure; 2. Zero hunger; Anemia; Middle Aged; Peptide Fragments; 3. Good health; Hospitalization; Italy; Multivariate Analysis; Heart Transplantation; Female

To assess the impact of comorbidities on long-term all-cause mortality in patients hospitalized with exacerbated signs/symptoms of previously chronic stable HF (AE-CHF).1119 patients admitted for AE-CHF and with NT-proBNP levels >900pg/mL were enrolled. Univariable and multivariable Cox analyses were performed to assess the association of age, gender, hypertension, diabetes, obesity, atrial fibrillation, coronary heart disease (CHD), chronic obstructive pulmonary disease, previous cerebrovascular accidents, chronic liver disease (CLD), thyroid disease, renal impairment (RI), and anemia with 3-year all-cause mortality.During the follow-up, 441 patients died and 126 underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. 45.8% of the fatal events and 52.4% of HT/VAD implantations occurred within 180days after admission. Increasing age (p=.012), obesity (p=.037), atrial fibrillation (p=.030), CHD (p=.015), CLD (p=.001), RI (p<.001), and anemia (p<.001) were independently associated with 3-year all-cause mortality. Most of the prognostic impact of CHD, took place within the first 180days after admission. Male gender was associated with mortality beyond 180days. Compared with normal weight, obesity was associated with better overall survival. Obese patients, however, had significantly lower NT-proBNP concentrations and less frequently presented with hypotension, hyponatremia, and severe left ventricular systolic dysfunction, despite a similar prevalence of severe dyspnea at admission.Several comorbidities are associated with long-term risk of death in hospitalized patients with worsening HF, although the nature of this association does appear to be complex. Our data may help to raise awareness about the clinical relevance of comorbid conditions.