Distinct Comorbidity Clusters in Patients With Acute Heart Failure

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure Pub Date : 2024-10-01 DOI:10.1016/j.jchf.2024.04.028

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引用次数: 0

Abstract

Background

Multimorbidity frequently occurs in patients with acute heart failure (AHF). The co-occurrence of comorbidities often follows specific patterns.

Objectives

This study investigated multimorbidity subtypes and their associations with clinical outcomes.

Methods

From the prospective RELAX-AHF-2 (Relaxin for the Treatment of Acute Heart Failure-2) trial, 6,545 patients (26% with HF with preserved ejection fraction, defined as LVEF ≥50%) were classified into multimorbidity groups using latent class analysis. The association between subgroups and clinical outcomes was examined. Validation of these findings was conducted in the RELAX-AHF trial, which comprised 1,161 patients.

Results

Five distinct multimorbidity groups emerged: 1) diabetes and chronic kidney disease (CKD) (often male, high prevalence of CKD and diabetes mellitus); 2) ischemic (ischemic HF); 3) elderly/atrial fibrillation (AF) (oldest, high prevalence of AF); 4) metabolic (obese, hypertensive, more often HF with preserved ejection fraction); and 5) young (fewest comorbidities). After adjusting for confounders, patients in the diabetes and CKD (HR: 1.80; 95% CI: 1.50-2.20), elderly/AF (HR: 1.42; 95% CI: 1.20-1.70), and metabolic (HR: 1.40; 95% CI: 1.20-1.80) groups had higher rates of the composite outcome than patients in the young group, primarily driven by differences in rehospitalization. Treatment allocation (placebo or serelaxin) modified these associations (P_interaction <0.001). Serelaxin-treated patients in the young group were associated with a lower risk for all-cause mortality (HR: 0.59; 95% CI: 0.40-0.90). Similarly, patients from the RELAX-AHF trial clustered in 5 multimorbidity groups. The clinical characteristics and associations with outcomes could also be validated.

Conclusions

Comorbidities naturally clustered into 5 mutually exclusive groups in RELAX-AHF-2, showing variations in clinical outcomes. These data emphasize that the specific combination of comorbidities can influence adverse outcomes and treatment responses in patients with AHF.

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急性心力衰竭患者的不同合并症群：来自 RELAX-AHF-2 的数据。

背景：急性心力衰竭（AHF）患者常合并多种疾病。合并症的共存往往遵循特定的模式：本研究调查了多病亚型及其与临床结果的关系：方法：在前瞻性的 RELAX-AHF-2（Relaxin for the Treatment of Acute Heart Failure-2，松弛素治疗急性心力衰竭-2）试验中，采用潜类分析法将 6545 名患者（其中 26% 为射血分数保留型心力衰竭患者，定义为 LVEF ≥50%）分为多病群组。研究了亚组与临床结果之间的关联。这些研究结果在由 1,161 名患者组成的 RELAX-AHF 试验中进行了验证：出现了五个不同的多病分组：1）糖尿病和慢性肾脏病（CKD）（通常为男性，CKD和糖尿病发病率高）；2）缺血性（缺血性心房颤动）；3）老年/房颤（AF）（年龄最大，房颤发病率高）；4）代谢性（肥胖、高血压，多为射血分数保留的心房颤动）；5）年轻（合并症最少）。在对混杂因素进行调整后，糖尿病和慢性肾脏病组（HR：1.80；95% CI：1.50-2.20）、老年/房颤组（HR：1.42；95% CI：1.20-1.70）和代谢组（HR：1.40；95% CI：1.20-1.80）患者的综合结果发生率高于年轻组患者，主要原因是再住院率的差异。治疗分配（安慰剂或丝裂霉素）改变了这些关联（Pinteraction结论）：在RELAX-AHF-2中，合并症自然地分为5个相互排斥的组别，并显示出不同的临床结果。这些数据强调，合并症的特定组合会影响急性重症肌无力患者的不良预后和治疗反应。

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

JACC. Heart failure CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

21.20

自引率

2.30%

发文量

164

期刊介绍： JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.