Key result
The presence of three or more comorbidities was strongly associated with an increased risk of hospitalization for acute heart failure (OR 5.81).
Why the study?
Heart failure frequently coexists with multiple comorbidities, but the prognostic role of various comorbidities in the risk of acute heart failure development needed evaluation.
Do specific comorbidities increase the risk of hospital admission for acute heart failure in patients with heart failure?
Cohort (n=430)
No
Do specific comorbidities increase the risk of hospital admission for acute heart failure in patients with heart failure?
A higher burden of comorbidities, specifically obesity, atrial fibrillation, peripheral artery disease, and chronic kidney disease, is independently associated with an increased risk of admission for acute heart failure.
INTRODUCTION: Heart failure frequently coexists with several comorbidities. Our aim is to evaluate the prognostic role of various comorbidities in the risk of acute heart failure development. MATERIAL AND METHODS: Comorbidities of patients with acute heart failure were, retrospectively, compared to a control group of patients with chronic heart failure admitted to an Internal Medicine unit in a 2-year period. Logistic regression models were constructed to determine their association with acute heart failure and to develop a comorbidome. RESULTS: We identified 229 patients with acute heart failure and 201 patients with chronic heart failure. Age and female gender were higher in acute heart failure group (p < 0.001) as was the number of comorbidities (4.0 ± 3.0 vs 4.0 ± 2.0, p = 0.044). Hyperuricemia (odds ratio 2.46, confidence interval 95% 1.41 - 4.31, p = 0.002), obesity (odds ratio 2.22, confidence interval 95% 1.31 - 3.76, p = 0.003), atrial fibrillation (odds ratio 1.93, confidence interval 95% 1.31 - 2.87, p = 0.001), peripheral artery disease (odds ratio 2.12, confidence interval 95% 1.01 - 4.42, p = 0.046) and chronic kidney disease (odds ratio 2.47, confidence interval 95% 1.65 - 3.71, p < 0.001) were associated with acute heart failure. Obesity, atrial fibrillation, peripheral artery disease and chronic kidney disease were identified as independent risk factors. Patients with multiple comorbidities had a superior risk of hospitalization due to heart failure: zero comorbidities - odds ratio 0.43, 95% confidence interval 0.28 - 0.67, p < 0.001; one comorbidity - odds ratio 0.69, 95% confidence interval 0.47 - 1.01, p = 0.057; two comorbidities - odds ratio 1.85, 95% confidence interval 1.11 - 3.08, p = 0.019; ≥ three comorbidities - odds ratio 5.81, 95% confidence interval 2.77 - 12.16, p < 0.001. DISCUSSION: This study shows an association between several comorbidities and hospital admission due to acute heart failure. The association seems to strengthen in the presence of multiple comorbidities. CONCLUSION: A comorbidome is a useful tool to identify comorbidities associated with higher risk of acute heart failure. The identification of vulnerable patients may allow multidimensional interventions to minimize future hospital admissions.
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Meireles et al. (2020) conducted a cohort in Acute Heart Failure (n=430). ≥3 comorbidities vs. Fewer comorbidities was evaluated on Hospitalization due to acute heart failure (OR 5.81, 95% CI 2.77-12.16, p=<0.001). The presence of three or more comorbidities was strongly associated with an increased risk of hospitalization for acute heart failure (OR 5.81).
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