Non-cardiac comorbidities and functional impairment in acute heart failure: a hospital-wide real-world cohort study (COMPACT-HF)

Acute heart failure (AHF) is a leading cause of hospitalization among older adults and is associated with non-cardiac comorbidities (NCCs) and functional impairment. Their prognostic and therapeutic implications remain incompletely characterized. COMPACT-HF was a retrospective cohort study of adults discharged after hospitalization for AHF at a tertiary teaching hospital in 2023. Comorbidity burden was assessed using the age-adjusted Charlson Comorbidity Index (CCI) and predefined NCCs. Functional impairment was defined as loss of ≥ 1 basic activity of daily living (ADL). Primary outcome was 12-month all-cause mortality. We included 456 patients (mean age 82.6 ± 8.6 years; 50% male); 96% had ≥ 1 NCC and 48% had functional impairment. Twelve-month mortality was 31%. CCI was independently associated with mortality (HR 1.17 per point; 95% CI 1.07-1.27, p < 0.001), while functional impairment provided additional prognostic information beyond comorbidity burden. Advanced chronic kidney disease, dementia, and active malignancy were among the NCCs most strongly associated with mortality. Among patients with reduced or mildly reduced ejection fraction, dementia, advanced chronic kidney disease, chronic lung disease, and functional impairment were associated with lower prescription of ≥ 3 of 4 guideline-directed medical therapy (GDMT) classes, whereas CCI was not; GDMT prescription also varied substantially according to discharge ward. In this hospital-wide real-world cohort of patients discharged alive after AHF hospitalization, NCCs and functional impairment were highly prevalent and associated with mortality, while specific clinical conditions and discharge ward were associated with GDMT implementation. Integrating comorbidity and functional assessment may improve risk stratification and support a holistic approach to AHF management.