The Effects of Cardiac and Non-cardiac Comorbidities on Survival in Patients with Heart Failure and Reduced Ejection Fraction

Abstract

Introduction: The management of “real world” patients with heart failure and reduced ejection fraction (HFREF) requires consideration of the incremental prognostic influence of advancing age, cardiac and non-cardiac comorbidities. Methods: We evaluated the prognostic utility of the age-adjusted Charlson comorbidity index (age-CCI) with respect to all-cause mortality in 516 consecutive patients with HFREF, enrolled within the GenesisCare Heart Failure Management clinics (GC-HFMCs). Age-CCI was dichotomised for analysis (above or below mean). Baseline characteristics and all-cause mortality at 1 year and intermediate term follow-up were compared between groups. Results: Mean age was 73 ± 12 years, 69% were male, and there was a history of myocardial infarction in 30%, atrial fibrillation (AF) in 55%, anaemia in 20% and 83% were NYHA class II-III. The mean age-CCI was 6 ± 3. Over a median follow-up of 1.7 years (IQR 1.0–2.6), there were 93 deaths (18%). High age-CCI was a strong predictor of mortality, however variables not within age-CCI also predicted mortality as seen in Table 1.Table 1All-cause mortality at 1.7 yearsOR95% CIp valueAge-CCI > mean (6)9.42.2–40.60.003Male Gender2.31.3–4.10.004Anaemia4.72.9–7.7<0.001AF2.01.3–3.30.004NYHANYHA II (OR 3.4, p = 0.02); NYHA III (OR 8.2, p < 0.001); NYHA IV (OR 9.1, p = 0.01) Open table in a new tab Conclusions: The age-CCI is a powerful predictor of mortality in patients with HFREF however additional cardiac and non-cardiac comorbidities need to be considered when evaluating the prognosis of complex patients.