Comorbidity patterns and mortality in HFpEF: A retrospective longitudinal cohort study

Figures

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  Fig. 1. Prevalence of Comorbidities by Age, Sex, and Rural vs. Urban Residence. 1A illustrates adjusted odds ratios (ORs) and 95 % confidence intervals (CI) for differences in the prevalence of measured 16 comorbidities between patients aged <70 and ≥ 70 years, shown by decreasing order of prevalence. 1B illustrates ORs and 95 % CIs for differences in the prevalence of 16 measured comorbidities between patients female and male patients, shown by decreasing order of prevalence. 1C illustrates ORs and 95 % CIs for differences in the prevalence of 16 measured comorbidities between patients from rural counties and those from urban counties, shown by decreasing order of prevalence. Abbreviations: CAD, coronary artery disease; CKD, chronic kidney disease, GI, gastrointestinal and hepatic condition; VHD, valvular heart disease.

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  Fig. 2. Adjusted Mortality by Comorbid Condition(s) 2A illustrates adjusted hazard ratios (HRs) with 95 % confidence intervals (CI) for all-cause mortality associated with comorbid conditions in the entire cohort, arranged by decreasing HRs. 2B illustrates adjusted HRs with 95 % CIs for all-cause mortality associated with comorbid conditions in patients aged <70 years, arranged by decreasing HRs. 2C illustrates adjusted HRs with 95 % CIs for all-cause mortality associated with comorbid conditions in patients aged ≥70 years, arranged by decreasing HRs. 2D illustrates adjusted HRs with 95 % CIs for all-cause mortality associated with comorbid conditions in female patients, arranged by decreasing HRs. 2E illustrates adjusted HRs with 95 % CIs for all-cause mortality associated with comorbid conditions in male patients, arranged by decreasing HRs. 2F illustrates adjusted HRs with 95 % CIs for all-cause mortality associated with comorbid conditions in patients from rural counties, arranged by decreasing HRs. 2G illustrates adjusted HRs with 95 % CIs for all-cause mortality associated with comorbid conditions in patients from urban counties, arranged by decreasing HRs. Abbreviations: CAD,…

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  Fig. 3. Prevalence and Exposure Duration of Comorbidities in the Entire Cohort. The figure illustrates the percentage of patients with each comorbidity, stratified by four exposure duration categories: <0.5 years, 0.5 to <3 years, 3 to <6 years, and ≥6 years. Comorbidities are listed in descending order of overall prevalence. Abbreviations: Afib, atrial fibrillation/flutter; CAD, coronary artery disease; CKD, chronic kidney disease; CLD, chronic lung condition; DM, diabetes mellitus; HLP, hyperlipidemia; HTN, hypertension; GI/hep, gastrointestinal and hepatic condition; Neuro, non-stroke neurological condition; Psych, psychiatric condition; Rheum, rheumatological condition; VHD, valvular heart disease.

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  Fig. 4. Modeling the Nonlinear Association Between length of Exposure to Comorbidities and Mortality Risk Using Restricted Cubic Spline Within a Cox Proportional Hazards Model.: Adjusted hazard ratios (HRs) and 95 % confidence intervals (CIs) for all-cause mortality are shown across the continuous range of comorbidity duration, modeled using restricted cubic splines (RCS) within a multivariable adjusted Cox proportional hazards model. Comorbidity duration was categorized into four levels: <0.5 years, 0.5–<3 years, 3–<6 years, and ≥6 years. RCS functioned with four knots placed at <0.5 years, 0.5–<3 years, 3–<6 years, and ≥6 years. The HR of 1.0 represents the reference point. The solid line represents the estimated mean mortality outcome, and shaded areas correspond to 95 % CI. Separate model was fitted for each measured comorbidity and 4 levels of exposure duration. The model was adjusted both patient- and hospital.

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  Fig. 5. Association of Comorbidities With Mortality at Discharge by SGLT2i Prescription. Caption: Forest plots display hazard ratios (HRs) with 95 % confidence intervals (CIs) for the association between comorbidities and mortality, stratified by discharge prescription of sodium–glucose cotransporter-2 inhibitors (SGLT2i). In the no-SGLT2i group, nearly all comorbidities, including hypertension, CAD, atrial fibrillation, stroke, diabetes, CKD, anemia, chronic lung, oncological, neurological, and psychiatric conditions, were consistently associated with significantly higher mortality (HRs 1.15–1.47; all p < 0.001), with the exception of obesity. In the SGLT2i group, the mortality risk was generally attenuated and did not reach statistical significance for many comorbidities, although risks remained elevated for stroke, CKD, chronic lung, and neurological conditions. Event counts, proportions, HRs, and p-values are presented in the table. Black diamonds indicate point estimates, with horizontal lines representing 95 % CIs.