Abstract Body (Do not enter title and authors here): Background: Heart failure (HF) may coexist with non-cardiac comorbidities. Yet, while relevant, the impact of non-cardiac comorbidities on long-term HF re-hospitalizations (Re-Hosp) is is not well established. Previous studies do not reflect modern HF management, often report just all-cause Re-Hosp, or are based on selected populations from randomizd trials.
We investigated the association of non-cardiac comorbidities with long-term Re-Hosp for HFafter discharge for HF in a large, contemporary setting.
Methods: Administrative hospital discharge data for HF (primary diagnosis) (Jan 1st 2015-Dec 31st 2019) of all >10 Million residents of Lombardy (Italy); follow up through June 30th 2021. Comorbidities assessed from discharge information and/or administrative codes for chronic diseases. Re-Hosp risk for HF (primary diagnosis) after HF discharge as a function of non-cardiac comorbidities was assessed by Cox proportional-hazard models (age- and sex-adjusted). Kaplan Meier curves for HFRe-Hosp were stratified for number of non-cardiac comorbidities.
Results: 88,528 consecutive patients received a HF primary discharge; over 42.8±18.3 months of follow-up, 79,533 HF Re-Hosp occurred (32.44/100 patient/year). Risk of HF Re-Hosp increased with increasing number of non-cardiac comorbidities. Adjusted by age, females with >4 comorbidities had a 3.08 (CI 2.73-3.47) greater risk of Re-Hosp compared with females without comorbidities; males with >4 comorbidities had a 2.62 (CI 2.39-2.87) greater risk compared with males without comorbidities. By multivariable analysis, number of comorbidities, age, and male sex, remained significantly associated with Re-Hosp risk (Figs 1, 2).
Risk of all-cause death also increased with increasing number of non-cardiac comorbidities, from 1.42 for HF patients with 1-2 comorbidities to 2.20 for HF patients with >4 comorbidities.
Also the number of days spent in hospital because of HF after index HF discharge significantly increased with increasing number of non-cardiac comorbidities, from 19.9±19.3 days in patients without non-cardiac comorbidities to 45.4±33.0 days for patients with >4 non-cardiac comorbidities (p<0.0001).
Conclusion: In a large, contemporary real-world series of patients hospitalized with HF, HF re-hospitalizations, all-cause mortality, and life-time spent in hospital due to worsening HF increased with number of non-cardiac comorbidities. Non-cardiac comorbidities substantially impact the clinical trajectory of HF patients.