impact of non cardiac comorbidity on mortality and morbidity in a predominantly elderly heart...
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Impact of non-cardiac comorbidity on mortality and morbidity in a predominantly elderly heart failure population among different heart failure
phenotypesA. Iorio*, M. Senni*, S. Poli§, E. Zambon§, G. Barbati°, G. Faganello°, G. Sinagra§, L. Tarantini°, G. Cioffi°, A. Di Lenarda°
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DISCLOSURES:NONE
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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
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BACKGROUND (2)
HFrEFLVEF ≤40%
HFpEF borderlineLVEF 41 to 49
%
HFpEFLVEF ≥ 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
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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
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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 EF12%HFrEF
22%
HFbEF13%
HFpEF53%
2765 pts
HFrEF25%
HFpEF60%
HFbEF15%
0%
2412 pts included
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RESULTSPopulation Characteristics
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RESULTSPopulation Characteristics : Comorbidities
P=0,018
P=0,038P=0,129
P=0,229
P=0,584
P=0,114P=0,500
P=0,134
P=0,886
P=0,726
P=0,502
P=0,050
P<0,001
P=0,156
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RESULTSPopulation Characteristics: number of
comorbidities
p=NS
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RESULTSTreatment
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RESULTSPrognostic impact of comorbidities on mortality (interaction
test)
Comorbidities included in 3C-HF
score
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RESULTS3C-HF score predictive power for mortality
(ROC curve)
Whole populationAUC = 0,735 (0,695-0,776)P<0,001
De Lang’s test for two ROC curves
HFpEF VS HFrEF -> p=0,2631HFbEF 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
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RESULTSOutcomes adjusted for age, sex and comorbidities
(multivariable Cox analysis)
P<0,01
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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
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THANK YOU