Impact of comorbidities in heart failure – prevalence, effect on functional status, and outcome in indian population: A single-center experience

Abstract

Background: We sought to estimate the prevalence of comorbidities in heart failure (HF) patients and their impact on functional status and clinical outcomes in Indian population. Patients and Methods: This prospective study was carried out at a tertiary care institute in North India. Patients were followed up prospectively for readmission and mortality for a median of 18 months. Results: A total of 113 HF patients were included in the study – 59 being HF with preserved ejection fraction (HFpEF) and 54 being HF with reduced ejection fraction (HFrEF). Patients with HFpEF were older (P = 0.03) with an equal proportion of males and females. Patients with HFpEF were less intensively treated with HF medications, particularly, spironolactone and other diuretics (P = 0.001). A total of 17 comorbidities were identified, and patients with HFpEF exhibited a higher burden of total and noncardiac comorbidities. After 18 months of follow-up, the all-cause readmissions and all-cause mortality were higher (P = 0.01) in patients with HFrEF as compared to HFpEF. The high New York Heart Association (NYHA) class, low ejection fraction, and high proBNP were associated with an increased risk of all-cause mortality. The mean Geriatric Nutritional Risk Index (GNRI) was significantly low in the HFrEF group (96.4 ± 10.8 vs. 102.3 ± 12.9, P = 0.009). Quality of life was poor in patients with HFrEF as compared with the HFpEF group, and 36-item Short-Form Health Survey score decreased proportionately with a decrease in EF. Multivariate analysis showed EF, GNRI, albumin (mg/dl), urea (mg/dl), sodium, and all-cause mortality to be associated with HF-related readmissions. Furthermore, NYHA class, urea (mg/dl), all-cause readmission, and HF-related readmission were seen to be associated with HF-related mortality. Conclusion: Despite differential prevalence, comorbidities exert substantial impact on the functional status in HFrEF as well as HFpEF patients. An individualized treatment approach based on comorbidities could provide a way forward, especially in low-resource countries.