Noncardiac comorbidities had similar impacts on mortality in HFpEF and HFrEF, except for COPD, which carried a higher mortality hazard in HFpEF (HR 1.62 vs 1.23; p=0.01 for interaction).
Cohort (n=9,442)
Yes
Does the prognostic impact of noncardiac comorbidities on hospitalization and mortality differ between patients with HFpEF and HFrEF?
Noncardiac comorbidities drive higher non-HF hospitalizations in HFpEF compared to HFrEF, though their individual impacts on mortality are largely similar between the two groups, with the exception of COPD.
Effect estimate: HR 1.62 (95% CI 1.36 to 1.92)
p-value: p=0.01 for interaction
OBJECTIVES: The aim of this study was to evaluate the prevalence and prognostic impacts of noncardiac comorbidities in patients with heart failure (HF) with preserved ejection fraction (HFpEF) compared with those with HF with reduced ejection fraction (HFrEF). BACKGROUND: There is a paucity of information on the comparative prognostic significance of comorbidities between patients with HFpEF and those with HFrEF. METHODS: In a national ambulatory cohort of veterans with HF, the comorbidity burden of 15 noncardiac comorbidities and the impacts of these comorbidities on hospitalization and mortality were compared between patients with HFpEF and those with HFrEF. RESULTS: The cohort consisted of 2,843 patients with HFpEF and 6,599 with HFrEF with 2-year follow-up. Compared with patients with HFrEF, those with HFpEF were older and had higher prevalence of chronic obstructive pulmonary disease, diabetes, hypertension, psychiatric disorders, anemia, obesity, peptic ulcer disease, and cancer but a lower prevalence of chronic kidney disease. Patients with HFpEF had lower HF hospitalization, higher non-HF hospitalization, and similar overall hospitalization compared with those with HFrEF (p < 0.001, p < 0.001, and p = 0.19, respectively). An Increasing number of noncardiac comorbidities was associated with a higher risk for all-cause admissions (p < 0.001). Comorbidities had similar impacts on mortality in patients with HFpEF compared with those with HFrEF, except for chronic obstructive pulmonary disease, which was associated with a higher hazard (1.62 95% confidence interval: 1.36 to 1.92 vs. 1.23 95% confidence interval: 1.11 to 1.37, respectively, p = 0.01 for interaction) in patients with HFpEF. CONCLUSIONS: There is a higher noncardiac comorbidity burden associated with higher non-HF hospitalizations in patients with HFpEF compared with those with HFrEF. However, individually, most comorbidities have similar impacts on mortality in both groups. Aggressive management of comorbidities may have an overall greater prognostic impact in HFpEF compared to HFrEF.
Ather et al. (2012) conducted a cohort in Heart failure with preserved versus reduced ejection fraction (n=9,442). Heart failure with preserved ejection fraction (HFpEF) vs. Heart failure with reduced ejection fraction (HFrEF) was evaluated on Mortality associated with chronic obstructive pulmonary disease (HR 1.62, 95% CI 1.36 to 1.92, p=0.01 for interaction). Noncardiac comorbidities had similar impacts on mortality in HFpEF and HFrEF, except for COPD, which carried a higher mortality hazard in HFpEF (HR 1.62 vs 1.23; p=0.01 for interaction).