Co‐morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey

<jats:sec><jats:title>Aims</jats:title><jats:p>Co‐morbidities frequently accompany heart failure (<jats:styled-content style="fixed-case">HF</jats:styled-content>), contributing to increased morbidity and mortality, and an impairment of quality of life. We assessed the prevalence, determinants, regional variation, and prognostic implications of co‐morbidities in patients with chronic <jats:styled-content style="fixed-case">HF</jats:styled-content> in Europe.</jats:p></jats:sec><jats:sec><jats:title>Methods and results</jats:title><jats:p>A total of 3226 European outpatients with chronic <jats:styled-content style="fixed-case">HF</jats:styled-content> were included in this analysis of the European Society of Cardiology (<jats:styled-content style="fixed-case">ESC</jats:styled-content>) Heart Failure Pilot Survey. The following co‐morbidities were considered: diabetes, hyper‐ and hypothyroidism, stroke, <jats:styled-content style="fixed-case">COPD</jats:styled-content>, sleep apnoea, chronic kidney disease (<jats:styled-content style="fixed-case">CKD</jats:styled-content>), and anaemia. Prognostic implications of co‐morbidities were evaluated using population attributable risks (<jats:styled-content style="fixed-case">PARs</jats:styled-content>), and patients were divided into geographic regions. Clinical endpoints were all‐cause mortality and <jats:styled-content style="fixed-case">HF</jats:styled-content> hospitalization. The majority of patients (74%) had a least one co‐morbidity, the most prevalent being <jats:styled-content style="fixed-case">CKD</jats:styled-content> (41%), anaemia (29%), and diabetes (29%). Co‐morbidities were independently associated with higher age (<jats:italic>P</jats:italic> < 0.001), higher <jats:styled-content style="fixed-case">NYHA</jats:styled-content> functional class (<jats:italic>P</jats:italic> < 0.001), ischaemic aetiology of <jats:styled-content style="fixed-case">HF</jats:styled-content> (<jats:italic>P</jats:italic> < 0.001), higher heart rate (<jats:italic>P</jats:italic> = 0.011), history of hypertension (<jats:italic>P</jats:italic> < 0.001), and <jats:styled-content style="fixed-case">AF</jats:styled-content> (<jats:italic>P</jats:italic> < 0.001). Only diabetes, <jats:styled-content style="fixed-case">CKD</jats:styled-content>, and anaemia were independently associated with a higher risk of mortality and/or <jats:styled-content style="fixed-case">HF</jats:styled-content> hospitalization. There were marked regional differences in prevalence and prognostic implications of co‐morbidities. Prognostic implications of co‐morbidities (<jats:styled-content style="fixed-case">PARs</jats:styled-content>) were: <jats:styled-content style="fixed-case">CKD</jats:styled-content> = 41%, anaemia = 37%, diabetes = 14%, <jats:styled-content style="fixed-case">COPD</jats:styled-content> = 10%, and <10% for all other co‐morbidities.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>In this pilot survey, co‐morbidities are prevalent in patients with chronic <jats:styled-content style="fixed-case">HF</jats:styled-content> and are related to the severity of the disease. The presence of diabetes, <jats:styled-content style="fixed-case">CKD</jats:styled-content>, and anaemia was independently related to increased mortality and <jats:styled-content style="fixed-case">HF</jats:styled-content> hospitalization, with the highest <jats:styled-content style="fixed-case">PAR</jats:styled-content> for <jats:styled-content style="fixed-case">CKD</jats:styled-content> and anaemia.</jats:p></jats:sec>