Comprehensive Characterization of Non-Cardiac Comorbidities in Acute Heart Failure- an analysis of ESC-HFA EORP Heart Failure Long-Term Registry

Purpose: To evaluate the prevalence and associations of non-cardiac comorbidities (NCC) with in-hospital and post-discharge outcomes in acute heart failure (AHF) across the ejection fraction (EF) spectrum. Methods: 9326 AHF patients from ESC-HFA-EORP-HF-Long-Term-Registry had complete information for the following 12 NCCs: anemia, chronic obstructive pulmonary disease (COPD), diabetes, depression, hepatic dysfunction, renal dysfunction, malignancy, Parkinson disease, peripheral vascular disease (PVD), rheumatoid arthritis, sleep apnoea, stroke/TIA(transient ischemic attack). Patients were classified by number of NCCs (0, 1, 2, 3, and ≥4). Results: Of AHF patients, 20.5% had no NCC, 28.5% had 1 NCC, 23.1% had 2 NCC, 15.4% had 3 NCC and 12.5% had ≥4 NCC. In-hospital and post-discharge mortality increased with number of NCCs from 3.0% and 18.5% for 1 NCC to 12.5% and 36% for ≥4 NCCs.Anemia, COPD, PVD, sleep apnoea, rheumatoid arthritis, stroke/TIA, Parkinson and depression were more prevalent in HFpEF. The hazard ratio (95% confidence interval) for post-discharge death for each NCC was for anemia 1.6 (1.4-1.8), diabetes 1.2 (1.1-1.4), kidney dysfunction 1.7 (1.5-1.9), COPD 1.4 (1.2-1.5), PVD 1.2 (1.1-1.4), stroke/TIA 1.3 (1.1-1.5), depression 1.2 (1.0-1.5), haepatic dysfunction 2.1 (1.8-2.5), malignancy 1.5 (1.2-1.8), sleep apnoea 1.2 (0.9-1.7), rheumatoid arthritis 1.5 (1.1-2.1) and Parkinson 1.4 (0.9-2.1). Anemia, kidney dysfunction, COPD and diabetes were associated with post-discharge mortality in all EF categories, PVD, stroke/TIA and depression only in HFrEF and sleep apnoea and malignancy only in HFpEF. Conclusion: Multiple NCCs conferred poor in-hospital and post-discharge outcomes. EF categories had different prevalence and risk profile associated with individual NCCs.