title: Heart failure prognosis: comorbidities matter.
abstract: BACKGROUND
  Prior risk prediction models have included a selective group of broad comorbidities in scoring prognosis of heart failure (HF) patients.
  
  
  OBJECTIVE
  We examined whether scoring a comprehensive set of comorbidities separately, could improve the performance and accuracy of predicting HF prognosis.
  
  
  METHODS
  This is a cross-validated, longitudinal, retrospective, observational study. Data were collected on 602,050 unique HF patients, who received care through the Veterans Administration (VA) between October 1, 2006 and September 31, 2011. The dependent variable was mortality in six months. The independent variables were all International Classification of Disease (ICD) comorbidities, without grouping into broad disease categories.
  
  
  RESULTS
  The area under the receiver-operating curve (AROC) for the multimorbidity (MM) index was 0.784 (95% confidence interval [CI]: 0.781-0.786). The MM index was significantly (alpha <0.05) more accurate than the Quan variant of the Charlson Index (AROC=0.656), the comorbidity categories within the Care Assessment of Need (CAN) Index (AROC=0.677), the von Walraven variant of the Elixhauser Index (AROC=0.639), chronological age (AROC=0.649), or ejection fraction (EF) (AROC=0.533).
  
  
  CONCLUSIONS
  Inclusion of additional comorbidities improves the accuracy of HF prognostic indices. Future studies are needed to drive HF prognostic indices with the MM index as a component.
authors: 1 Office of Chief of Staff, Veterans Affairs Medical Center , Washington, DC.
authors: Raya E
authors: RE
authors: Kheirbek
authors: Farrokh
authors: F
authors: Alemi
authors: Ross
authors: R
authors: Fletcher
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D016017:Odds Ratio; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data