Abstract
Heart failure frequently coexists with several comorbidities. Our aim is to evaluate the prognostic role of various comorbiditiesin the risk of acute heart failure development. Comorbidities of patients with acute heart failure were, retrospectively, compared to a control group of patientswith chronic heart failure admitted to an Internal Medicine unit in a 2-year period. Logistic regression models were constructed to determinetheir association with acute heart failure and to develop a comorbidome. We identified 229 patients with acute heart failure and 201 patients with chronic heart failure. Age and female gender werehigher 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 wereidentified as independent risk factors. Patients with multiple comorbidities had a superior risk of hospitalization due to heart failure: zerocomorbidities - odds ratio 0.43, 95% confidence interval 0.28 - 0.67, p < 0.001; one comorbidity - odds ratio 0.69, 95% confidenceinterval 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. This study shows an association between several comorbidities and hospital admission due to acute heart failure. Theassociation seems to strengthen in the presence of multiple comorbidities. A comorbidome is a useful tool to identify comorbidities associated with higher risk of acute heart failure. The identificationof vulnerable patients may allow multidimensional interventions to minimize future hospital admissions.
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