title: Association between cardiovascular vs. non-cardiovascular co-morbidities and outcomes in heart failure with preserved ejection fraction.
abstract: OBJECTIVE
  The prevalence of cardiovascular and non-cardiovascular co-morbidities and their relative importance for outcomes in heart failure with preserved ejection fraction (HFPEF) remain poorly characterized. This study aimed to investigate this.
  
  
  RESULTS
  The Karolinska-Rennes (KaRen) Study was a multinational prospective observational study designed to characterize HFPEF. Inclusion required acute HF, defined by the Framingham criteria, LVEF ≥ 45%, and NT-pro-BNP ≥ 300 ng/L or BNP ≥ 100 ng/L. Detailed clinical data were collected at baseline and patients were followed prospectively for 18 months. Predictors of the primary (HF hospitalization or all-cause mortality) and secondary (all-cause mortality) outcomes were assessed with multivariable Cox regression. A total of 539 patients [56% women; median (interquartile range) age 79 (72-84) years; NT-pro-BNP/BNP 2448 (1290-4790)/429 (229-805) ng/L] were included. Known history of HF was present in 40%. Co-morbidities included hypertension (78%), atrial fibrillation/flutter (65%), anaemia (51%), renal dysfunction (46%), CAD (33%), diabetes (30%), lung disease (25%), and cancer (16%). The primary outcome occurred in 268 patients [50%; 106 deaths (20%) and 162 HF hospitalizations (30%)]. Important independent predictors of the primary and/or secondary outcomes were age, history of non-cardiovascular syncope, valve disease, anaemia, lower sodium, and higher potassium, but no cardiovascular co-morbidities. Renin-angiotensin system antagonist and mineralocorticoid receptor antagonist use predicted improved prognosis.
  
  
  CONCLUSIONS
  HFPEF was associated with higher age, female gender, hypertension, atrial fibrillation/flutter, and numerous non-cardiovascular co-morbidities. Prognosis was determined by non-cardiovascular co-morbidities, but use of conventional heart failure medications may still be associated with improved outcomes.
authors.affiliation: Karolinska Institutet, Department of Medicine, Stockholm, Sweden; Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden.
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.forename: Camilla
authors.initials: C
authors.lastname: Hage
authors.forename: Hans
authors.initials: H
authors.lastname: Persson
authors.forename: Ida
authors.initials: I
authors.lastname: Haugen-Löfman
authors.forename: Pierre-Vladimir
authors.initials: PV
authors.lastname: Ennezat
authors.forename: Catherine
authors.initials: C
authors.lastname: Sportouch-Dukhan
authors.forename: Elodie
authors.initials: E
authors.lastname: Drouet
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Daubert
authors.forename: Cecilia
authors.initials: C
authors.lastname: Linde
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000453:epidemiology*; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology*; D008171:Lung Diseases / Q000453:epidemiology*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
keywords: Co-morbidity; Diastolic function; Diastolic heart failure; Heart failure with preserved ejection fraction; Outcomes