COMORBIDITIES
Free Access
Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey
Vincent M. van Deursen,
Renato Urso,
Cecile Laroche, Kevin Damman,
Ulf Dahlström,
Luigi Tavazzi,
Aldo P. Maggioni, Adriaan A. Voors,
Vincent M. van Deursen
Department of Cardiology, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorRenato Urso
Pharmacology Unit ‘Giorgio Segre’, University of Siena, Siena, Italy
Search for more papers by this authorKevin Damman
Department of Cardiology, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorUlf Dahlström
Department of Cardiology, Linkoping University Hospital, Linkoping, Sweden
Search for more papers by this authorLuigi Tavazzi
GVM Care and Research, Ettore Sansavini Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy
Search for more papers by this authorCorresponding Author
Adriaan A. Voors
Department of Cardiology, University of Groningen, Groningen, The Netherlands
Corresponding author. Department of Cardiology, University Medical Center Groningen Hanzeplein 1, 9700 RB Groningen, The Netherlands. Tel: +31 503 612 355, Fax: +31 503 614 391, Email: [email protected]Search for more papers by this authorVincent M. van Deursen,
Renato Urso,
Cecile Laroche, Kevin Damman,
Ulf Dahlström,
Luigi Tavazzi,
Aldo P. Maggioni, Adriaan A. Voors,
Vincent M. van Deursen
Department of Cardiology, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorRenato Urso
Pharmacology Unit ‘Giorgio Segre’, University of Siena, Siena, Italy
Search for more papers by this authorKevin Damman
Department of Cardiology, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorUlf Dahlström
Department of Cardiology, Linkoping University Hospital, Linkoping, Sweden
Search for more papers by this authorLuigi Tavazzi
GVM Care and Research, Ettore Sansavini Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy
Search for more papers by this authorCorresponding Author
Adriaan A. Voors
Department of Cardiology, University of Groningen, Groningen, The Netherlands
Corresponding author. Department of Cardiology, University Medical Center Groningen Hanzeplein 1, 9700 RB Groningen, The Netherlands. Tel: +31 503 612 355, Fax: +31 503 614 391, Email: [email protected]Search for more papers by this authorAbstract
Aims
Co-morbidities frequently accompany heart failure (HF), contributing to increased morbidity and mortality, and an impairment of quality of life. We assessed the prevalence, determinants, regional variation, and prognostic implications of co-morbidities in patients with chronic HF in Europe.
Methods and results
A total of 3226 European outpatients with chronic HF were included in this analysis of the European Society of Cardiology (ESC) Heart Failure Pilot Survey. The following co-morbidities were considered: diabetes, hyper- and hypothyroidism, stroke, COPD, sleep apnoea, chronic kidney disease (CKD), and anaemia. Prognostic implications of co-morbidities were evaluated using population attributable risks (PARs), and patients were divided into geographic regions. Clinical endpoints were all-cause mortality and HF hospitalization. The majority of patients (74%) had a least one co-morbidity, the most prevalent being CKD (41%), anaemia (29%), and diabetes (29%). Co-morbidities were independently associated with higher age (P < 0.001), higher NYHA functional class (P < 0.001), ischaemic aetiology of HF (P < 0.001), higher heart rate (P = 0.011), history of hypertension (P < 0.001), and AF (P < 0.001). Only diabetes, CKD, and anaemia were independently associated with a higher risk of mortality and/or HF hospitalization. There were marked regional differences in prevalence and prognostic implications of co-morbidities. Prognostic implications of co-morbidities (PARs) were: CKD = 41%, anaemia = 37%, diabetes = 14%, COPD = 10%, and <10% for all other co-morbidities.
Conclusion
In this pilot survey, co-morbidities are prevalent in patients with chronic HF and are related to the severity of the disease. The presence of diabetes, CKD, and anaemia was independently related to increased mortality and HF hospitalization, with the highest PAR for CKD and anaemia.
References
- 1McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Ronnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Orn S, Parissis JT, Ponikowski P. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012; 14: 803–869.
- 2van der Meer P, Voors AA, Lipsic E, van Gilst WH, van Veldhuisen DJ. Erythropoietin in cardiovascular diseases. Eur Heart J 2004; 25: 285–291.
- 3Hillege HL, Nitsch D, Pfeffer MA, Swedberg K, McMurray JJ, Yusuf S, Granger CB, Michelson EL, Ostergren J, Cornel JH, de Zeeuw D, Pocock S, van Veldhuisen DJ, Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Investigators. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation 2006; 113: 671–678.
- 4Macchia A, Monte S, Romero M, D'Ettorre A, Tognoni G. The prognostic influence of chronic obstructive pulmonary disease in patients hospitalized for chronic heart failure. Eur J Heart Fail 2007; 9: 942–948.
- 5Braunstein JB, Anderson GF, Gerstenblith G, Weller W, Niefeld M, Herbert R, Wu AW. Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. J Am Coll Cardiol 2003; 42: 1226–1233.
- 6van Deursen VM, Damman K, van der Meer P, Wijkstra PJ, Luijckx GJ, van Beek A, van Veldhuisen DJ, Voors AA. Co-morbidities in heart failure. Heart Fail Rev 2012; doi:10.1007/s10741-012-9370-7, in press.
- 7Ather S, Chan W, Bozkurt B, Aguilar D, Ramasubbu K, Zachariah AA, Wehrens XH, Deswal A. Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol 2012; 59: 998–1005.
- 8Saczynski JS, Go AS, Magid DJ, Smith DH, McManus DD, Allen L, Ogarek J, Goldberg RJ, Gurwitz JH. Patterns of comorbidity in older adults with heart failure: the Cardiovascular Research Network PRESERVE study. J Am Geriatr Soc 2013; 61: 26–33.
- 9Maggioni AP, Dahlstrom U, Filippatos G, Chioncel O, Leiro MC, Drozdz J, Fruhwald F, Gullestad L, Logeart D, Metra M, Parissis J, Persson H, Ponikowski P, Rauchhaus M, Voors A, Nielsen OW, Zannad F, Tavazzi L, Heart Failure Association of ESC (HFA). EURObservational Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 2010; 12: 1076–1084.
- 10Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L, INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet 2004; 364: 937–952.
- 11Groenveld HF, Januzzi JL, Damman K, van Wijngaarden J, Hillege HL, van Veldhuisen DJ, van der Meer P. Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol 2008; 52: 818–827.
- 12Damman K, Voors AA, Hillege HL, Navis G, Lechat P, van Veldhuisen DJ, Dargie HJ, CIBIS-2 Investigators and Committees. Congestion in chronic systolic heart failure is related to renal dysfunction and increased mortality. Eur J Heart Fail 2010; 12: 974–982.
- 13Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol 2009; 53: 582–588.
- 14Voors AA, van der Horst IC. Diabetes: a driver for heart failure. Heart 2011; 97: 774–780.
- 15Javaheri S. Sleep disorders in systolic heart failure: a prospective study of 100 male patients. The final report. Int J Cardiol 2006; 106: 21–28.
- 16Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, Roselle GA. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation 1998; 97: 2154–2159.
- 17Javaheri S, Parker TJ, Wexler L, Michaels SE, Stanberry E, Nishyama H, Roselle GA. Occult sleep-disordered breathing in stable congestive heart failure. Ann Intern Med 1995; 122: 487–492.
- 18Vazir A, Hastings PC, Dayer M, McIntyre HF, Henein MY, Poole-Wilson PA, Cowie MR, Morrell MJ, Simonds AK. A high prevalence of sleep disordered breathing in men with mild symptomatic chronic heart failure due to left ventricular systolic dysfunction. Eur J Heart Fail 2007; 9: 243–250.
- 19Lanfranchi PA, Somers VK, Braghiroli A, Corra U, Eleuteri E, Giannuzzi P. Central sleep apnea in left ventricular dysfunction: prevalence and implications for arrhythmic risk. Circulation 2003; 107: 727–732.
- 20Oldenburg O, Lamp B, Faber L, Teschler H, Horstkotte D, Topfer V. Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients. Eur J Heart Fail 2007; 9: 251–257.
- 21Ferrier K, Campbell A, Yee B, Richards M, O'Meeghan T, Weatherall M, Neill A. Sleep-disordered breathing occurs frequently in stable outpatients with congestive heart failure. Chest 2005; 128: 2116–2122.
- 22Herrscher TE, Akre H, Overland B, Sandvik L, Westheim AS. High prevalence of sleep apnea in heart failure outpatients: even in patients with preserved systolic function. J Card Fail 2011; 17: 420–425.
- 23Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail 2009; 11: 130–139.
- 24Hawkins NM, Jhund PS, Simpson CR, Petrie MC, Macdonald MR, Dunn FG, Macintyre K, McMurray JJ. Primary care burden and treatment of patients with heart failure and chronic obstructive pulmonary disease in Scotland. Eur J Heart Fail 2010; 12: 17–24.
- 25Iversen KK, Kjaergaard J, Akkan D, Kober L, Torp-Pedersen C, Hassager C, Vestbo J, Kjoller E, ECHOS Lung Function Study Group. The prognostic importance of lung function in patients admitted with heart failure. Eur J Heart Fail 2010; 12: 685–691.
- 26Batcher EL, Tang XC, Singh BN, Singh SN, Reda DJ, Hershman JM, SAFE-T Investigators. Thyroid function abnormalities during amiodarone therapy for persistent atrial fibrillation. Am J Med 2007; 120: 880–885.
- 27Edelmann F, Stahrenberg R, Gelbrich G, Durstewitz K, Angermann CE, Dungen HD, Scheffold T, Zugck C, Maisch B, Regitz-Zagrosek V, Hasenfuss G, Pieske BM, Wachter R. Contribution of comorbidities to functional impairment is higher in heart failure with preserved than with reduced ejection fraction. Clin Res Cardiol 2011; 100: 755–764.
- 28Zelis R, Sinoway LI, Musch TI, Davis D, Just H. Regional blood flow in congestive heart failure: concept of compensatory mechanisms with short and long time constants. Am J Cardiol 1988; 62: 2E–8E.
- 29Levine TB, Olivari MT, Garberg V, Sharkey SW, Cohn JN. Hemodynamic and clinical response to enalapril, a long-acting converting-enzyme inhibitor, in patients with congestive heart failure. Circulation 1984; 69: 548–553.
- 30Saxena PR, Schoemaker RG. Organ blood flow protection in hypertension and congestive heart failure. Am J Med 1993; 94: 4S–12S.
- 31van Deursen VM, Damman K, Hillege HL, van Beek AP, van Veldhuisen DJ, Voors AA. Abnormal liver function in relation to hemodynamic profile in heart failure patients. J Card Fail 2010; 16: 84–90.
- 32Lenzen MJ, Boersma E, Reimer WJ, Balk AH, Komajda M, Swedberg K, Follath F, Jimenez-Navarro M, Simoons ML, Cleland JG. Under-utilization of evidence-based drug treatment in patients with heart failure is only partially explained by dissimilarity to patients enrolled in landmark trials: a report from the Euro Heart Survey on Heart Failure. Eur Heart J 2005; 26: 2706–2713.
- 33Komajda M, Lapuerta P, Hermans N, Gonzalez-Juanatey JR, van Veldhuisen DJ, Erdmann E, Tavazzi L, Poole-Wilson P, Le Pen C. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. Eur Heart J 2005; 26: 1653–1659.
- 34Peters-Klimm F, Muller-Tasch T, Schellberg D, Remppis A, Barth A, Holzapfel N, Junger J, Herzog W, Szecsenyi J. Guideline adherence for pharmacotherapy of chronic systolic heart failure in general practice: a closer look on evidence-based therapy. Clin Res Cardiol 2008; 97: 244–252.
- 35Levin ML. The occurrence of lung cancer in man. Acta Unio Int Contra Cancrum 1953; 9: 531–541.
- 36Berry C, Brett M, Stevenson K, McMurray JJ, Norrie J. Nature and prognostic importance of abnormal glucose tolerance and diabetes in acute heart failure. Heart 2008; 94: 296–304.
- 37Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, Lin JK, Farzadfar F, Khang YH, Stevens GA, Rao M, Ali MK, Riley LM, Robinson CA, Ezzati M, Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Glucose). National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 2011; 378: 31–40.
- 38Tomova GS, Nimbal V, Horwich TB. Relation between hemoglobin a(1c) and outcomes in heart failure patients with and without diabetes mellitus. Am J Cardiol 2012; 109: 1767–1773.
- 39Smooke S, Horwich TB, Fonarow GC. Insulin-treated diabetes is associated with a marked increase in mortality in patients with advanced heart failure. Am Heart J 2005; 149: 168–174.
- 40Damy T, Margarit L, Noroc A, Bodez D, Guendouz S, Boyer L, Drouot X, Lamine A, Paulino A, Rappeneau S, Stoica MH, Dubois-Rande JL, Adnot S, Hittinger L, d'Ortho MP. Prognostic impact of sleep-disordered breathing and its treatment with nocturnal ventilation for chronic heart failure. Eur J Heart Fail 2012; 14: 1009–1019.
- 41Jilek C, Krenn M, Sebah D, Obermeier R, Braune A, Kehl V, Schroll S, Montalvan S, Riegger GA, Pfeifer M, Arzt M. Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study. Eur J Heart Fail 2011; 13: 68–75.
- 42Nichols M, Townsend N, Scarborough P, Luengo-Fernandez R, Leal J, Gray A, Rayner M. European Cardiovascular Disease Statistics 2012. Brussels: European Society of Cardiology; Sophia Antipolis: European Heart Network; 2012.
Citing Literature
