title: Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prevalence and prognostic impacts of noncardiac comorbidities in patients with heart failure (HF) with preserved ejection fraction (HFpEF) compared with those with HF with reduced ejection fraction (HFrEF).
  
  
  BACKGROUND
  There is a paucity of information on the comparative prognostic significance of comorbidities between patients with HFpEF and those with HFrEF.
  
  
  METHODS
  In a national ambulatory cohort of veterans with HF, the comorbidity burden of 15 noncardiac comorbidities and the impacts of these comorbidities on hospitalization and mortality were compared between patients with HFpEF and those with HFrEF.
  
  
  RESULTS
  The cohort consisted of 2,843 patients with HFpEF and 6,599 with HFrEF with 2-year follow-up. Compared with patients with HFrEF, those with HFpEF were older and had higher prevalence of chronic obstructive pulmonary disease, diabetes, hypertension, psychiatric disorders, anemia, obesity, peptic ulcer disease, and cancer but a lower prevalence of chronic kidney disease. Patients with HFpEF had lower HF hospitalization, higher non-HF hospitalization, and similar overall hospitalization compared with those with HFrEF (p < 0.001, p < 0.001, and p = 0.19, respectively). An Increasing number of noncardiac comorbidities was associated with a higher risk for all-cause admissions (p < 0.001). Comorbidities had similar impacts on mortality in patients with HFpEF compared with those with HFrEF, except for chronic obstructive pulmonary disease, which was associated with a higher hazard (1.62 [95% confidence interval: 1.36 to 1.92] vs. 1.23 [95% confidence interval: 1.11 to 1.37], respectively, p = 0.01 for interaction) in patients with HFpEF.
  
  
  CONCLUSIONS
  There is a higher noncardiac comorbidity burden associated with higher non-HF hospitalizations in patients with HFpEF compared with those with HFrEF. However, individually, most comorbidities have similar impacts on mortality in both groups. Aggressive management of comorbidities may have an overall greater prognostic impact in HFpEF compared to HFrEF.
authors.affiliation: Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Ather
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
authors.forename: David
authors.initials: D
authors.lastname: Aguilar
authors.forename: Kumudha
authors.initials: K
authors.lastname: Ramasubbu
authors.forename: Amit A
authors.initials: AA
authors.lastname: Zachariah
authors.forename: Xander H T
authors.initials: XH
authors.lastname: Wehrens
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013318:Stroke Volume; D014481:United States / Q000453:epidemiology