Original articles / Online first

Burden of multimorbidity in a Polish cohort of ambulatory and hospitalized heart failure patients from two large European registry programs: prognostic implications

Radosław Sierpiński, Paweł Franczuk, Michał Tkaczyszyn, Tomasz Suchocki, Jan Krekora, Grzegorz Opolski, Aldo Maggioni, Lech Poloński, Piotr Ponikowski, Ewa A. Jankowska
Published online: September 29, 2021

Introduction: Individual comorbidities have been shown to adversely affect prognosis in heart failure (HF). However, our knowledge on the phenomenon of multimorbidity in HF and the understanding of its prognostic implications still remains incomplete.

Objectives: We aimed to analyze the prevalence of multimorbidity in Polish HF patients and to investigate the quantitative and qualitative impact of comorbidity burden on 12-month outcomes in these subjects.

Patients and Methods: We retrospectively analyzed data of 1765 Polish patients with ambulatory or acute (hospitalized) HF from 2 multicenter observational European Society of Cardiology registries - ESC-HF Pilot Survey (2009-2010) and ESC-HF-LT Registry (2011-2013).

Results: Arterial hypertension and coronary artery disease (CAD) were the most prevalent comorbidities, analogously to the entire European cohort. The great majority of HF patients had more than one predefined comorbidity and the most frequent number of comorbidities was three. Importantly, in almost half of the patients four or more concomitant disease syndromes were reported. The best accuracy for predicting the adjusted 12-month rate of all-cause death was ensured by the model comprising only anemia and kidney dysfunction. The model comprising four comorbidities - anemia, kidney dysfunction, diabetes, and CAD - provided best accuracy for predicting 12-month rate of composite all-cause death or HF hospitalization.

Conclusions: Multimorbidity is highly prevalent in a real-world cohort of Polish HF patients and the quantitative burden of comorbidities is related to increased mortality. In such patients the clinical profile characterized by pathophysiological continuum of diabetes, kidney dysfunction, and anemia particularly relates to unfavorable outcomes.

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