301 - The Burden of Non-Cardiac Comorbidities in Acute Heart Failure: Insights From ASCEND-HF

Abstract

Background: Non-cardiac comorbidities are common in heart failure (HF) but the association between non-cardiac comorbidities (NCC) and outcomes in acute HF has not been well-characterized. Purpose: To determine the prevalence and prognostic implications of NCC in acute HF patients enrolled in Acute Study of Clinical Effectiveness of Nesiritide in Decompensated HF (ASCEND-HF) clinical trial. Methods: A post-hoc study analyzed 7070 patients admitted with complete comorbidity profiles irrespective of ejection fraction (EF). The following eleven NCC were collected at baseline: alcohol abuse, anemia, cancer, cerebrovascular disease, chronic respiratory disease, depression, diabetes mellitus, end-stage renal disease, liver disease, peripheral arterial disease, and smoking. Patients were grouped as having 0, 1, 2, 3, and ≥4 NCC. Prevalence of comorbidity was assessed across groups in patients with preserved EF (i.e. >40%) and reduced EF (i.e. ≤40%). The association between the burden of NCC and the composite of 30-day mortality or HF hospitalization and 180-day mortality were assessed with 0 NCC as the reference group. Results: Patients had a mean age of 65 ± 14 years and 66% were male. The prevalence of 0, 1, 2, 3, and ≥4 NCC were 9%, 26%, 30%, 20%, and 15% respectively (Figure). Significantly higher levels of comorbidity were seen in patients from North America/Western Europe compared to patients from Central Europe/Asia Pacific. Patients with preserved EF had a higher comorbidity burden overall. After adjustment, a greater number of NCC was associated with increased risk of 30-day mortality/ HF hospitalization in patients with 2 (Odds Ratio [OR] 2.09; 95% CI 1.16–3.76), 3 (OR 2.47; 95% CI 1.33–4.56), and ≥4 NCC (OR 3.32; 95% CI 1.74–5.99). The presence of 2 and 3 NCC approached significance with respect to 180-day mortality, while ≥4 NCC was associated with significantly higher rates of 180-day mortality (Hazard Ratio [HR] 2.44, 95% CI 1.53–3.88). Conclusion(s): The prevalence of NCC is high in patients with acute HF. The presence of 2 or more NCC is strongly associated with increased risk of death or hospitalization for worsening HF.