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The contribution of comorbidities to mortality in hospitalized patients with heart failure

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Abstract

Background

Heart failure (HF) with reduced ejection fraction (HFrEF) has a worse prognosis than HF with preserved EF (HFpEF). The study aimed to evaluate whether different comorbidity profiles of HFrEF- and HFpEF-patients or HF-specific mechanisms contribute to a greater extent to this difference.

Methods

We linked data from two health insurances to data from a cardiology clinic hospital information system. Patients with a hospitalization with HF in 2005–2011, categorized as HFrEF (EF < 45%) or HFpEF (EF ≥ 45%), were propensity score (PS) matched to controls without HF on comorbidites and medication to assure similar comorbidity profiles of patients and their respective controls. The balance of the covariates in patients and controls was compared via the standardized difference (SDiff). Age-standardized 1-year mortality rates (MR) with 95% confidence intervals (CI) were calculated.

Results

777 HFrEF-patients (1135 HFpEF-patients) were PS-matched to 3446 (4832) controls. Balance between patients and controls was largely achieved with a SDiff < 0.1 on most variables considered. The age-standardized 1-year MRs per 1000 persons in HFrEF-patients and controls were 267.8 (95% CI 175.9–359.8) and 86.1 (95% CI 70.0–102.3). MRs in HFpEF-patients and controls were 166.2 (95% CI 101.5–230.9) and 61.5 (95% CI 52.9–70.1). Thus, differences in MRs between patients and their controls were higher for HFrEF (181.7) than for HFpEF (104.7).

Conclusions

Given the similar comorbidity profiles between HF-patients and controls, the higher difference in mortality rates between HFrEF-patients and controls points more to HF-specific mechanisms for these patients, whereas for HFpEF-patients a higher contribution of comorbidity is suggested by our results.

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References

  1. Bui AL, Horwich TB, Fonarow GC (2011) Epidemiology and risk profile of heart failure. Nat Rev Cardiol 8:30–41

    Article  PubMed  Google Scholar 

  2. Zarrinkoub R, Wettermark B, Wandell P et al (2013) The epidemiology of heart failure, based on data for 2.1 million inhabitants in Sweden. Eur J Heart Fail 15:995–1002

    Article  PubMed  Google Scholar 

  3. Stork S, Handrock R, Jacob J et al (2017) Epidemiology of heart failure in Germany: a retrospective database study. Clin Res Cardiol 106:913–922

    Article  PubMed  PubMed Central  Google Scholar 

  4. Stork S, Handrock R, Jacob J et al (2017) Treatment of chronic heart failure in Germany: a retrospective database study. Clin Res Cardiol 106:923–932

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brouwers FP, de Boer RA, van der Harst P et al (2013) Incidence and epidemiology of new onset heart failure with preserved vs. reduced ejection fraction in a community-based cohort: 11-year follow-up of PREVEND. Eur Heart J 2013 34:1424–1431

    Article  PubMed  CAS  Google Scholar 

  6. Kannel W (2000) Incidence and epidemiology of heart failure. Heart Fail Rev 5:167–173

    Article  PubMed  CAS  Google Scholar 

  7. Lee GKM, Lee LC, Liu CWY et al (2010) Framingham risk score inadequately predicts cardiac risk in young patients presenting with a first myocardial infarction. Ann Acad Med Singap 39:163–167

    PubMed  Google Scholar 

  8. Lam CSP, Donal E, Kraigher-Krainer E, Vasan RS (2011) Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail 13:18–28

    Article  PubMed  Google Scholar 

  9. in patients with heart failure with preserved ejection fraction stratified by study design: a systematic review. Eur J Heart Fail 18: 54–65

  10. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251–259

    Article  PubMed  CAS  Google Scholar 

  11. Paulus WJ, van Ballegoij JJM (2010) Treatment of heart failure with normal ejection fraction an inconvenient truth! J Am Coll Cardiol 55:526–537

    Article  PubMed  Google Scholar 

  12. Somaratne JB, Berry C, McMurray JJV, Poppe KK, Doughty RN, Whalley GA (2009) The prognostic significance of heart failure with preserved left ventricular ejection fraction: a literature-based meta-analysis. Eur J Heart Fail 11:855–862

    Article  PubMed  Google Scholar 

  13. Fonarow GC, Stough WG, Abraham WT et al (2007) Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure—a report from the OPTIMIZE-HF registry. J Am Coll Cardiol 50:768–777

    Article  PubMed  Google Scholar 

  14. Yancy CW, Lopatin M, Stevenson LW et al (2006) Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function—a report from the Acute Decompensated Heart Failure National Registry (ADHERE) database. J Am Coll Cardiol 47:76–84

    Article  PubMed  Google Scholar 

  15. Dahlstrom U (2005) Frequent non-cardiac comorbidities in patients with chronic heart failure. Eur J Heart Fail 7:309–316

    Article  PubMed  Google Scholar 

  16. Rutten FH, Cramer MJM, Lammers JWJ, Grobbee DE, Hoes AW (2006) Heart failure and chronic obstructive pulmonary disease: An ignored combination? Eur J Heart Fail 8:706–711

    Article  PubMed  Google Scholar 

  17. Hsich EM, Grau-Sepulveda MV, Hernandez AF et al (2012) Sex differences in in-hospital mortality in acute decompensated heart failure with reduced and preserved ejection fraction. Am Heart J 163:430-U380

    Article  Google Scholar 

  18. Jiang W, Alexander J, Christopher E et al (2001) Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med 161:1849–1856

    Article  PubMed  CAS  Google Scholar 

  19. Paulus WJ, Tschope C (2013) A novel paradigm for heart failure with preserved ejection fraction comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 62:263–271

    Article  PubMed  Google Scholar 

  20. Zile MR, Baicu CF, Gaasch WH (2004) Diastolic heart failure—abnormalities in active relaxation and passive stiffness of the left ventricle. New Engl J Med 350:1953–1959

    Article  PubMed  CAS  Google Scholar 

  21. Zile MR, Gottdiener JS, Hetzel SJ et al (2011) Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation 124:2491–2501

    Article  PubMed  Google Scholar 

  22. Massie BM, Carson PE, McMurray JJ et al (2008) Irbesartan in patients with heart failure and preserved ejection fraction. New Engl J Med 359:2456–2467

    Article  PubMed  CAS  Google Scholar 

  23. Solomon SD, Claggett B, Lewis EF et al (2016) Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J 37:455–462

    Article  PubMed  CAS  Google Scholar 

  24. Parsons L (2001) Reducing bias in a propensity score matched-pair sample using greedy matching techniques. SUGI26. Paper 214–26

  25. Chiang C (1967) Standard error of the age-adjusted death rate. Vital Statistics—Special Reports, Selected Studies 47

  26. Mentz RJ, Kelly JP, von Lueder TG et al (2014) Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction. J Am Coll Cardiol 64:2281–2293

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hogg K, Swedberg K, McMurray J (2004) Heart failure with preserved left ventricular systolic function: epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol 43:317–327

    Article  PubMed  Google Scholar 

  28. Centres for Medicare & Medicaid Services (2012) Chronic conditions among medicare benificiaries—Chartboo, 2012 Edition. Centes for Medicare & Medicaid Services, Baltimore

    Google Scholar 

  29. Tschope C, Birner C, Bohm M et al (2018) Heart failure with preserved ejection fraction: current management and future strategies. Clin Res Cardiol 107:1–19

    Article  PubMed  Google Scholar 

  30. van Deursen VM, Urso R, Laroche C et al (2014) Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail 16:103–111

    Article  PubMed  Google Scholar 

  31. Ruigomez A, Michel A, Martin-Perez M, Rodriguez LAG (2016) Heart failure hospitalization: an important prognostic factor for heart failure re-admission and mortality. Int J Cardiol 220:855–861

    Article  PubMed  Google Scholar 

  32. Ather S, Chan W, Bozkurt B et al (2012) Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol 59:998–1005

    Article  PubMed  PubMed Central  Google Scholar 

  33. Felker GM, Shaw LK, Stough WG, O’Connor CM (2006) Anemia in patients with heart failure and preserved systolic function. Am Heart J 151:457–462

    Article  PubMed  Google Scholar 

  34. MacDonald MR, Petrie MC, Varyani F et al (2008) Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure. Eur Heart J 29:1377–1385

    Article  PubMed  Google Scholar 

  35. Smith DH, Thorp ML, Gurwitz JH et al (2013) Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction the cardiovascular research network PRESERVE study. Circ Cardiovasc Qual Outcomes 6:333–342

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lupon J, Diez-Lopez C, de Antonio M et al (2017) Recovered heart failure with reduced ejection fraction and outcomes: a prospective study. Eur J Heart Fail 19:1615–1623

    Article  PubMed  Google Scholar 

  37. Chang HJ, Chen PC, Yang CC, Su YC, Lee CC (2016) Comparison of Elixhauser and Charlson methods for predicting oral cancer survival. Medicine 95

  38. Li B, Evans D, Faris P, Dean S, Quan H (2008) Risk adjustment performance of Charlson and Elixhauser comorbidities in ICD-9 and ICD-10 administrative databases. BMC Health Serv Res 8

  39. Sharabiani MTA, Aylin P, Bottle A (2012) Systematic review of comorbidity indices for administrative data. Med Care 50:1109–1118

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors are grateful to the statutory health insurances AOK Bremen/Bremerhaven and AOK Niedersachsen for contributing data to the study. This study was supported by Bayer AG, Germany.

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Correspondence to Oliver Riedel.

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Conflict of interest

A Michel and D Vizcaya are full-time employees of Bayer AG. J. Berg is a full-time employee of the statutory health insurance AOK Bremen/Bremerhaven. S. Eberhard is full-time employee of the statutory health insurance AOK Niedersachsen. O. Riedel, D. Enders, N. Schlothauer, A. Elsässer and C. Ohlmeier have nothing to disclose.

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Riedel, O., Ohlmeier, C., Enders, D. et al. The contribution of comorbidities to mortality in hospitalized patients with heart failure. Clin Res Cardiol 107, 487–497 (2018). https://doi.org/10.1007/s00392-018-1210-x

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  • DOI: https://doi.org/10.1007/s00392-018-1210-x

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