Prognostic impact of noncardiac comorbidities on hospitalization-associated disability and 1-year outcomes in older patients with heart failure — Findings from the J-proof HF

BACKGROUND This study aimed to assess the prevalence of noncardiac comorbidities (NCCs) and their association with hospitalization-associated disability (HAD) and 1-year outcomes in older patients with acute heart failure (HF). METHODS Ninety-six institutions participated in this prospective, nationwide, multicenter registry of older patients with HF (J-Proof HF). Of the 10,052 eligible patients, 852 were excluded based on the study exclusion criteria, 9200 older patients with HF (mean age 82 ± 8 years; women, 48.8%) were included in the subanalysis. We evaluated 14 predefined NCCs based on the Charlson Comorbidity Index plus anemia, and classified patients by NCCs count (0, 1, 2, ≥3). We examined associations between NCCs category and HAD, 1-year all-cause mortality, HF hospitalization, and noncardiovascular hospitalization. RESULTS Among the patients, 1107(12.0%) had no comorbidities (0 NCCs), 2615 (28.4%) had 1 NCC, 2919 (31.7%) had 2 NCCs, and 2559 (27.8%) had ≥3 NCCs. The incidence of HAD increased progressively across NCC categories (28.6%, 32.9%, 34.9%, and 39.8%; p for trend <0.001). Higher NCC category was associated with 1-year all-cause mortality after adjusting for confounders [hazard ratios were 1.099 (95% CI, 0.860-1.403) for 1 NCC, 1.382 (95% CI, 1.092-1.748) for 2 NCCs, and 1.873 (95% CI, 1.482-2.368) for ≥3 NCCs]. Similarly, higher NCC categories was significantly associated with HF hospitalization and noncardiovascular hospitalization. CONCLUSIONS NCCs are highly prevalent in older patients with HF. A greater NCC burden was associated with a higher incidence of HAD and poorer 1-year outcomes.