Impact of Non-cardiac Comorbidities on Long-Term Clinical Outcomes and Health Status After Acute Heart Failure in China

Xiqian Huo; Lihua Zhang; Xueke Bai; Guangda He; Jiaying Li; Fengyu Miao; Jiapeng Lu; Jiamin Liu; Xin Zheng; Jing Li

doi:10.3389/fcvm.2022.883737

Impact of Non-cardiac Comorbidities on Long-Term Clinical Outcomes and Health Status After Acute Heart Failure in China

Front Cardiovasc Med. 2022 Jul 13:9:883737. doi: 10.3389/fcvm.2022.883737. eCollection 2022.

Authors

Xiqian Huo¹, Lihua Zhang¹, Xueke Bai¹, Guangda He¹, Jiaying Li¹, Fengyu Miao¹, Jiapeng Lu¹, Jiamin Liu¹, Xin Zheng¹, Jing Li¹

Affiliation

¹ National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: Individual non-cardiac comorbidities are prevalent in HF; however, few studies reported how the aggregate burden of non-cardiac comorbidities affects long-term outcomes, and it is unknown whether this burden is associated with changes in health status.

Aims: To assess the association of the overall burden of non-cardiac comorbidities with clinical outcomes and quality of life (QoL) in patients hospitalized for heart failure (HF).

Methods: We prospectively enrolled patients hospitalized for HF from 52 hospitals in China. Eight key non-cardiac comorbidities [diabetes, chronic renal disease, chronic obstructive pulmonary disease (COPD), anemia, stroke, cancer, peripheral arterial disease (PAD), and liver cirrhosis] were included, and patients were categorized into four groups: none, one, two, and three or more comorbidities. We fitted Cox proportional hazards models to assess the burden of comorbidities on 1-year death and rehospitalization.

Results: Of the 4,866 patients, 25.3% had no non-cardiac comorbidity, 32.2% had one, 22.9% had two, and 19.6% had three or more in China. Compared with those without non-cardiac comorbidities, patients with three or more comorbidities had higher risks of 1-year all-cause death [heart rate, HR 1.89; 95% confidence interval (CI) 1.48-2.39] and all-rehospitalization (HR 1.35; 95%CI 1.15-1.58) after adjustment. Although all patients with HF experienced a longitudinal improvement in QoL in the 180 days after discharge, those with three or more non-cardiac comorbidities had an unadjusted 11.4 (95%CI -13.4 to -9.4) lower Kansas City Cardiomyopathy Questionnaire (KCCQ) scores than patients without comorbidities. This difference decreased to -6.4 (95%CI -8.6 to -4.2) after adjustment for covariates.

Conclusion: Among patients hospitalized with HF in this study, a higher burden of non-cardiac comorbidities was significantly associated with worse health-related QoL (HRQoL), increased risks of death, and rehospitalization post-discharge. The findings highlight the need to address the management of comorbidities effectively in standardized HF care.

Keywords: KCCQ; heart failure; non-cardiac comorbidities; outcomes; quality of life.