Prognostic impact of comorbidities in hospitalized patients with acute exacerbation of chronic heart failure.
BACKGROUND
To assess the impact of comorbidities on long-term all-cause mortality in patients hospitalized with exacerbated signs/symptoms of previously chronic stable HF (AE-CHF).


METHODS
1119 patients admitted for AE-CHF and with NT-proBNP levels >900pg/mL were enrolled. Univariable and multivariable Cox analyses were performed to assess the association of age, gender, hypertension, diabetes, obesity, atrial fibrillation, coronary heart disease (CHD), chronic obstructive pulmonary disease, previous cerebrovascular accidents, chronic liver disease (CLD), thyroid disease, renal impairment (RI), and anemia with 3-year all-cause mortality.


RESULTS
During the follow-up, 441 patients died and 126 underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. 45.8% of the fatal events and 52.4% of HT/VAD implantations occurred within 180days after admission. Increasing age (p=.012), obesity (p=.037), atrial fibrillation (p=.030), CHD (p=.015), CLD (p=.001), RI (p<.001), and anemia (p<.001) were independently associated with 3-year all-cause mortality. Most of the prognostic impact of CHD, took place within the first 180days after admission. Male gender was associated with mortality beyond 180days. Compared with normal weight, obesity was associated with better overall survival. Obese patients, however, had significantly lower NT-proBNP concentrations and less frequently presented with hypotension, hyponatremia, and severe left ventricular systolic dysfunction, despite a similar prevalence of severe dyspnea at admission.


CONCLUSIONS
Several comorbidities are associated with long-term risk of death in hospitalized patients with worsening HF, although the nature of this association does appear to be complex. Our data may help to raise awareness about the clinical relevance of comorbid conditions.
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy. Electronic address: domenico.scrutinio@fsm.it.
Domenico
D
Scrutinio
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
Andrea
A
Passantino
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
Pietro
P
Guida
Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy; San Raffaele Hospital and Vita-Salute University, Milan, Italy.
Enrico
E
Ammirati
Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
Fabrizio
F
Oliva
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Tradate, Varese, Italy.
Simona Sarzi
SS
Braga
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Montescano, Pavia, Italy.
Maria Teresa
MT
La Rovere
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
Rocco
R
Lagioia
Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
Maria
M
Frigerio
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D058625:End Stage Liver Disease / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery; D016027:Heart Transplantation; D006760:Hospitalization; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009765:Obesity / Q000453:epidemiology; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
Acute decompensated heart failure; Comorbidity; Mortality