Impact of non cardiac comorbidity on mortality and morbidity in a predominantly elderly heart failure population

1. Impact of non-cardiac comorbidity on mortality
and morbidity in a predominantly elderly heart
failure population among different heart failure
phenotypes
A. Iorio*, M. Senni*, S. Poli§, E. Zambon§, G. Barbati°, G. Faganello°, G.
Sinagra§, L. Tarantini°, G. Cioffi°, A. Di Lenarda°

2. DISCLOSURES:
NONE

3. BACKGROUND (1)
• Heart Failure occurs across the entire range of
LVEF
• Cardiovascular and non-cardiovascular
comorbidities have a significant impact on
prognosis
• Patients with HFpEF have usually a heavier
burden of comorbidities
• 3C-HF is a score based on cardiac and comorbid
conditions which was shown to prognostically
stratify Heart Failure patients

4. BACKGROUND (2)
HFrEF
LVEF ≤40%
HFpEF borderline
LVEF 41 to 49
%
HFpEF
LVEF ≥ 50%
• There is paucity of information on the impact of comorbidities
across Heart Failure phenotypes according to LVEF
• The combined role of comoribidities on prognosis has non
been widely investigated
• Most of the studies on HFpEF vs HFrEF are so far hardly
comparable
• Inhomogeneity of population characteristics
• High variability of cutoffs of LVEF

5. AIM
To compare the prevalence and relative impact
on prognosis of a wide range of noncardiac
comorbidities, combined in 3C-HF score, across
ACCF/AHA phenotypes

6. METHODS
• Retrospective study on data derived from the E-chart for Outpatient Clinic
(Cardionet®), collected in a regional Data Warehouse
• Data from Outpatients Clinics of Cardiovascular Center and Cardiovascular
Department, Trieste, Italy, which account for 87,1% of ambulatory
evaluations in Trieste area
• Inclusion criteria: 2412 consecutive (from October 2009 to November
2013) Heart Failure out-patients with known ejection fraction
Missing
EF
12%HFrEF
22%
HFbEF
13%
HFpEF
53%
2765
pts
HFrEF
25%
HFpEF
60%
HFbEF
15%
0%
2412 pts
included

7. RESULTS
Population Characteristics

8. RESULTS
Population Characteristics : Comorbidities
P=0,018
P=0,038
P=0,129
P=0,229
P=0,584
P=0,114
P=0,500
P=0,134
P=0,886
P=0,726
P=0,502
P=0,050
P<0,001
P=0,156

9. RESULTS
Population Characteristics: number of
comorbidities
p=NS

10. RESULTS
Treatment

11. RESULTS
Prognostic impact of comorbidities on mortality (interaction
test)
Comorbidities
included in 3C-HF
score

12. RESULTS
3C-HF score predictive power for mortality
(ROC curve)
Whole population
AUC = 0,735 (0,695-0,776)
P<0,001
De Lang’s test for two ROC curves
HFpEF VS HFrEF -> p=0,2631
HFbEF VS HFrEF -> p=0,0914
AUC CI p
HFrEF 0,764 0,703-0,826 <0,001
HFpEF
borderline
0,632 0,494-0,769 0,05
HFpEF 0,717 0,660-0,773 <0,001

13. RESULTS
Outcomes adjusted for age, sex and comorbidities
(multivariable Cox analysis)
P<0,01

14. CONCLUSIONS
• High comorbidity burden contributed significantly to high
rates of mortality and morbidity
• Comorbidities had similar prognostic impact on mortality
across all HF phenotypes
• Multiparametric 3C-HF score showed satisfying prognostic
accuracy, similar in all HF phenotypes
In the setting of elderly HF patients, the management
of comorbidities could have a crucial role on prognosis
irrespective of HF phenotype

15. THANK
YOU