Time-Dependent Markers of Comorbidity Severity and Change are Associated with Increased Risk of Mortality in Heart Failure: A National Study of the English General Population

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Purpose

Heart failure (HF) comorbid with other chronic diseases carries poor prognosis, which changes over time. How the comorbid disease severity and change influences prognosis is unknown. We hypothesised that in the HF population, comorbidity stratification by increasing severity and longitudinal change would be associated with increased mortality.

Methods

We used a case-control study nested within the UK Clinical Practice Research Datalink database (12-year time-period to 2014), of newly diagnosed HF patients aged over 40 years. Using risk set sampling, four controls were matched to cases on calendar and follow-up time. Comorbid medication or physiological exposures of change for diabetes mellitus (HbA1c) and renal dysfunction (eGFR) were measured in two time-windows covering 1-year, prior to the match date. Conditional logistic regression was

Results

Of the 50,114 HF patients, 27,729 died. HF comorbidity stratified by DM medications compared to without DM was associated with mortality as follows: none (adjusted RR 1.37, 95% CI 1.29-1.46), oral hypoglycaemics (1.17,1.11-1.22) and insulin only (1.56,1.44-1.68). Estimates for recent DM HbA1c change were: same or >1% increase (1.23,1.18-1.29) and >1% decrease (1.49,1.37-1.61). For RD, compared to a prior annual decrease in eGFR of <5%, a decrease of >25% was associated with a higher mortality

Conclusions

In the general population, HF comorbidity stratification by severity and change are important prognostic markers of mortality which need to be incorporated into prognostic models.

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