Co-morbidities in long term prognosis in patients with acute heart failure

Introduction and purpose: Acute heart failure (AHF) is the term used to describe the rapid onset of, or change in, symptoms and signs of HF. In most cases, AHF arises as a result of deterioration in patients with a previous diagnosis of HF. Prognosis in acute heart failure depends on numerous factors. In our prospective study we investigated the influence of the most frequent co-morbidities on 1 year prognosis in patients with AHF. Methods and results: In our prospective study we included 603 consecutive patients (60.7% men) with AHF treated in Intensive Care Unit. The average age was 71.5±10.4 years. 29.9% had acute coronary syndrome, 27.9% dilatative cardiomyopathy, 23.9% arterial hypertension and 18.4% valvular disease as an etiology factor for HF. 66.7% of patients had HF with reduced LVEF (37.4±13.7%), the average duration of HF was 1.7±1.1 years. Cardiovascular comorbidities: arterial hypertension (80.6%) and atrial fibrillation (47.3%) were the most frequent. The most prevalent non-cardiovascular comorbidities were diabetes (54.7%), chronic renal failure (CRF: 43.3%), acute infections (32.8%), anaemia (26.4%), chronic obstructive pulmonary disease (COPD: 23.9%), depression (10%), hypothyreosis (8%), hyperthyreosis (7.5%), stroke (7.5%) and alcoholism (5.5%). The majority of patients had > 1 co-morbidity (32.8% patients had 3 and 31.8% had 2 associated comorbidities). Arterial hypertension, atrial fibrillation and CRF were most frequently associated. During 1 year follow up mortality was admittedly high: 42.8% (10% died in hospital, 12.9% during 6 months after hospital discharge and 19.9% until the end of follow up period). Logistic regression analysis included all relevant factors (age, gender, echocardiographic, clinical, biohumoral parameters) and co-morbidities. We found that higher mortality rate was associated with alcoholism (13.1 fold increase), COPD (5.52 fold increase), CRF (5.1 fold increase) and the number of co-morbidities (5.07 fold increase) as well as with female gender, low LVEF and NYHA class. Co-morbidities did not have influence on in-hospital mortality. Conclusion: In our study we found that majority AHF patients had 3 jointed (non)cardiovascular comorbidities which were associated with significantly higher mortality after hospital discharge. Meticulous diagnosis and treatment of all co-morbidities should be the routine part of clinical evaluation in AHF since it could improve long-term prognosis. However it seems that we are far from its practical implementation.