Acute Heart Failure Comorbidome: The Impact of Everything Else

• Autor(a) principal: Meireles, Mariana
• Data de Publicação: 2020
• Outros Autores: Gonçalves, João, Neves, João
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.16/2469
• topic: Comorbidity; Heart Failure; Hospitalization; Mortality

Introduction: Heart failure frequently coexists with several comorbidities. Our aim is to evaluate the prognostic role of various comorbidities in the risk of acute heart failure development. Material and methods: Comorbidities of patients with acute heart failure were, retrospectively, compared to a control group of patients with chronic heart failure admitted to an Internal Medicine unit in a 2-year period. Logistic regression models were constructed to determine their association with acute heart failure and to develop a comorbidome. Results: We identified 229 patients with acute heart failure and 201 patients with chronic heart failure. Age and female gender were higher in acute heart failure group (p < 0.001) as was the number of comorbidities (4.0 ± 3.0 vs 4.0 ± 2.0, p = 0.044). Hyperuricemia (odds ratio 2.46, confidence interval 95% 1.41 - 4.31, p = 0.002), obesity (odds ratio 2.22, confidence interval 95% 1.31 - 3.76, p = 0.003), atrial fibrillation (odds ratio 1.93, confidence interval 95% 1.31 - 2.87, p = 0.001), peripheral artery disease (odds ratio 2.12, confidence interval 95% 1.01 - 4.42, p = 0.046) and chronic kidney disease (odds ratio 2.47, confidence interval 95% 1.65 - 3.71, p < 0.001) were associated with acute heart failure. Obesity, atrial fibrillation, peripheral artery disease and chronic kidney disease were identified as independent risk factors. Patients with multiple comorbidities had a superior risk of hospitalization due to heart failure: zero comorbidities - odds ratio 0.43, 95% confidence interval 0.28 - 0.67, p < 0.001; one comorbidity - odds ratio 0.69, 95% confidence interval 0.47 - 1.01, p = 0.057; two comorbidities - odds ratio 1.85, 95% confidence interval 1.11 - 3.08, p = 0.019; ≥ three comorbidities - odds ratio 5.81, 95% confidence interval 2.77 - 12.16, p < 0.001. Discussion: This study shows an association between several comorbidities and hospital admission due to acute heart failure. The association seems to strengthen in the presence of multiple comorbidities. Conclusion: A comorbidome is a useful tool to identify comorbidities associated with higher risk of acute heart failure. The identification of vulnerable patients may allow multidimensional interventions to minimize future hospital admissions.