Even a Low Comorbidity Burden Predicts Poor Outcomes in Chronic Heart Failure.

Q3 Medicine

Critical Pathways in Cardiology Pub Date : 2024-12-01 Epub Date: 2024-06-21 DOI:10.1097/HPC.0000000000000368

Catarina Elias, Ana Neves, Rita Gouveia, Sérgio Madureira, Pedro Ribeirinho-Soares, Marta Soares-Carreira, Joana Pereira, Jorge Almeida, Patrícia Lourenço

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引用次数: 0

Abstract

Background: Patients with heart failure often have multiple cardiovascular risk factors (CVRFs) and comorbidities (CMBs). We evaluated the impact of additive CMB and CVRF on heart failure prognosis.

Methods: We retrospectively analyzed ambulatory patients with systolic dysfunction between January 2012 and May 2018. Follow-up was until January 2021. The endpoint was all-cause death. CVRF analyzed arterial hypertension, diabetes mellitus, and smoking. CMB evaluated coronary artery disease, noncoronary atherosclerotic disease, respiratory disease, dementia, anemia, chronic kidney disease, inflammatory/autoimmune disease, active cancer, and atrial fibrillation. Classification according to the number of CVRFs and/or CMBs is <2 and ≥2. The independent prognostic impact of CVRF/CMB burden was assessed with multivariate Cox regression.

Results: Most patients had ≥2 CMBs (67.9%). Regarding CVRF, 14.9% presented none, 40.2% had 1, and 32.1% had 2. During a median 49-month follow-up, 419 (49.1%) patients died. Mortality was higher among patients with ≥2 CVRFs (56.1 versus 43.4% in those with <2) and in those with ≥2 CMBs (57.7 versus 31.0%). While patients with 1 CMB had similar mortality than those with none. Patients with ≥2 CMBs had higher long-term mortality risk: hazard ratio (HR), 2.47 (95% CI, 1.95-3.14). In patients with ≥2CVRFs, the HR of dying is 1.39 (95% CI, 1.14-1.70). When taken together, there was a clear survival disadvantage for patients with ≥2 CVRFs/CMBs-adjusted HR, 2.20 (95% CI, 1.45-3.34).

Conclusions: The presence of only 2 CVRFs/CMBs more than doubles the patients´ risk of dying. CVRF and CMB should be assessed as part of routine patient management.

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即使合并症负担较低，也会导致慢性心力衰竭患者预后不佳。

背景：心力衰竭（HF）患者通常具有多种心血管风险因素（CVRF）和合并症（CMB）。我们评估了CMB和CVRF叠加对HF预后的影响：我们对 2012 年 1 月至 2018 年 5 月期间患有收缩功能障碍的流动患者进行了回顾性分析。随访：直至 2021 年 1 月。终点：全因死亡。分析了 CVRF：动脉高血压、糖尿病和吸烟。CMB评估：冠状动脉疾病、非冠状动脉粥样硬化性疾病、呼吸系统疾病、痴呆、贫血、慢性肾脏疾病、炎症/自身免疫性疾病、活动性癌症和心房颤动。根据 CVRF 和/或 CMB 的数量进行分类：< 2 和 ≥ 2。通过多变量 Cox 回归评估了 CVRF/CMB 负担对预后的独立影响：大多数患者的CMB≥2（67.9%）。在CVRF方面，14.9%的患者无CVRF，40.2%的患者有1个，32.1%的患者有2个。在中位 49 个月的随访期间，419 名患者（49.1%）死亡。CVRF≥2个的患者死亡率更高（56.1%对43.4%）：仅有 2 个 CVRF/CMB 会使患者的死亡风险增加一倍以上。CVRF和CMB应作为常规患者管理的一部分进行评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Pathways in Cardiology Medicine-Medicine (all)

CiteScore

1.90

自引率

0.00%

发文量

期刊介绍： Critical Pathways in Cardiology provides a single source for the diagnostic and therapeutic protocols in use at hospitals worldwide for patients with cardiac disorders. The Journal presents critical pathways for specific diagnoses—complete with evidence-based rationales—and also publishes studies of these protocols" effectiveness.