Association of chronic heart failure and its comorbidities with loss of actuarially predicted life expectancy: a prospective cohort study

Background: Estimating survival can aid care planning, but the use of absolute survival projections can be challenging for patients and clinicians to contextualize. We aimed to define how heart failure and its major comorbidities contribute to loss of actuarially predicted life expectancy. Methods: We conducted an observational cohort study of 1794 adults with stable chronic heart failure and reduced left ventricular ejection fraction, recruited from cardiology outpatient departments of 4 United Kingdom (UK) hospitals. Data from an 11-year maximum (5-year median) follow-up period (999 deaths) was used to define how heart failure and its major comorbidities impact upon survival, relative to an age-sex matched control UK population, using a relative survival framework. Results: After 10 years, mortality in the reference control population was 29%. In people with heart failure, this increased by an additional 37% (95% confidence interval 34-40%), equating to an additional 2.2-years of lost life, or a 2.4-fold (2.2-2.5) excess loss of life. This excess was greater in men than women (2.4 years [2.2-2.7] versus 1.6 years [1.2-2.0]; p<0.001). In patients without major comorbidity, men still experienced excess loss of life, whilst women experienced less and were non-significantly different from the reference population (1 year [0.6-1.5] versus 0.4 years [-0.3-1]; p<0.001). Accrual of comorbidity was associated with substantial increases in excess loss of life, particularly for chronic kidney and lung disease. Conclusions: Comorbidity accounts for the majority of lost life expectancy in people with heart failure. Women, but not men, without comorbidity experience survival close to reference controls.