Impact of Noncardiac Comorbidities on Morbidity and Mortality in a Predominantly Male Population With Heart Failure and Preserved Versus Reduced Ejection Fraction

Abstract

Objectives To evaluate the prevalence and prognostic impact of non-cardiac comorbidities in patients with heart failure (HF) with preserved ejection fraction (HFpEF) versus heart failure with reduced ejection fraction (HFrEF). Background There is paucity of information on the comparative prognostic significance of comorbidities between HFpEF and HFrEF patients. Methods In a national ambulatory cohort of Veterans with HF, we compared the comorbidity burden of 15 non-cardiac comorbidities and the impact of these comorbidities on hospitalization and mortality between HFpEF and HFrEF patients. Results The cohort consisted of 2,843 HFpEF and 6,599 HFrEF patients with 2 year follow-up. Compared to HFrEF, HFpEF patients were older and had higher prevalence of chronic obstructive pulmonary disease (COPD), diabetes, hypertension, psychiatric disorders, anemia, obesity, peptic ulcer disease and cancer, but lower prevalence of chronic kidney disease. HFpEF patients had lower HF hospitalization, higher non-HF hospitalization and similar overall hospitalization, compared with HFrEF patients (p<0.001, p<0.001, p=0.19, respectively). Increasing number of non-cardiac comorbidities was associated with higher risk of all-cause admissions (p<0.001). Comorbidities had similar impact on mortality in HFpEF vs. HFrEF patients except for COPD, which was associated with a higher hazard (1.62 [95% CI 1.36-1.92] vs. 1.23 [95% CI 1.11, 1.37], respectively; p=0.01 for interaction) in HFpEF patients. Conclusions There is a higher non-cardiac comorbidity burden associated with higher non-HF hospitalizations in HFpEF compared to HFrEF patients. However, individually, most comorbidities have similar impact on mortality in both groups. Aggressive management of comorbidities may have an overall greater prognostic impact in HFpEF compared to HFrEF.