Abstract 18283: Prognostic Impact of Comorbidities on Mortality in Patients with Heart failure and Preserved Ejection Fraction vs Heart Failure with Reduced Ejection Fraction
Introduction: Previous studies showed that patients with heart failure with preserved ejection fraction (HFPEF) had a higher proportion of non-cardiovascular deaths compared with heart failure with reduced ejection fraction (HFREF).
Hypothesis: Non-cardiovascular comorbidities have a greater adverse prognostic impact on mortality in HFPEF, compared with HFREF patients.
Methods: In an ambulatory national cohort of Veterans with HF, we compared the prevalence of 14 comorbidities between HFPEF (EF≥50%) and HFREF patients. We compared the prognostic impact of these comorbidities on all cause mortality between HFPEF and HFREF patients using Cox regression and separately used interaction analysis to evaluate the interaction between comorbidities and EF group.
Results: The cohort consisted of 2843 HFPEF and 6599 HFREF patients with complete 2-year follow-up. HFPEF patients were older in comparison with HFREF patients (71±10 vs. 70±10 years). In comparison with HFREF patients, HFPEF patients had a significantly higher prevalence of COPD (34% vs. 27%), diabetes (45% vs. 40%), hypertension (71% vs. 62%), psychiatric history (28% vs. 23%), obesity (51% vs. 35%), anemia (30% vs. 28%) and cancer (22% vs. 19%), but lower prevalence of CKD (49% vs. 52%). There was a significant trend in the prevalence of HFPEF (using chi-square for trend) among groups classified by numbers of co-morbidities (p<0.001; Figure). Comorbidities had similar prognostic impact on mortality in HFPEF vs. HFREF patients except for COPD, which had a higher hazard ratio (HR) (1.6 vs. 1.2, p=0.007) and diabetes which had a lower HR (0.99 vs. 1.2, p=0.046) in HFPEF, compared with HFREF patients. Conclusions: Although there is a higher prevalence of comorbidities in HFPEF in comparison with HFREF patients, most comorbidities have comparable prognostic impact on mortality in both groups. Therefore, similar aggressive management of comorbidities is warranted in patients with HFPEF, as well as HFREF.
- © 2010 by American Heart Association, Inc.