Comorbidities and survival after acute decompensated heart failure hospitalisation

Background Heart failure (HF) presents a poor prognosis and is frequently associated with comorbidities. Less is known on interplays between comorbidities and HF type on survival. Aims To precise the relationship between comorbidities, HF type and two-years survival after acute HF (AHF) episode. Methods A local PMSI register was retrospectively screened to include all discharged patients in two cardiology centers, in 2013. Fifteen comorbidities were collected and tertilized, depending on the number and nature of comorbidities (C): cardiovascular (CVC) and non-cardiovascular (NCVC). The three HF type were defined according to left ventricular ejection fraction (LVEF) and ESC 2016 guidelines: reduced (HF-rEF), mid-range (HF-mrEF) and preserved EF (HF-pEF). All-cause mortality two years after discharge was the main end-point. Results Among 577 patients recruited, mean age was 78 years (55% male) and 37% had rEF, 21% mrEF and 42% pEF. Two-years overall mortality was 42% and did not differ in the three HF population. Mean number of all comorbidities (AC) was 4.4, CVC 1.9 and NCVC 2.5, similar in the three HF populations ( Table 1 ). HF-rEF patients were younger male with coronary artery disease. HF-pEF had higher proportions of women, atrial fibrillation and hypertension. The HF-mrEF group presented intermediate profile. High number of comorbidities were associated with impaired survival ( Fig. 1 ). After stratification on LVEF, mortality in HF-rEF population significantly increased with the augmentation of AC, CVC and NCVC. HF-mrEF population tended to look like HF-rEF one, showing a significant increasing mortality with the augmentation of AC and NCVC, but not in CVC. There was no association between mortality and co-morbidities in HF-pEF population. Conclusion Comorbidities are associated with increased 2-year mortality after AHF episode. After stratification, mortality increases with comorbidities in HF-rEF and HF-mrEF, but not in HF-pEF population.