1. Heart failure and comorbidities
Analysis of the European Heart Failure Pilot Survey
van Deursen VM et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Europ J Heart Fail. 2014;16:

2. Zoom on patients with comorbidities in Europe
Comorbidities frequently accompany heart failure,
leading to increased morbidity and mortality, and decreased quality of life.
3226
outpatients with
chronic heart failure
analysed
AIM OF THE ANALYSIS
Assessing the
- prevalence,
- prognostic implications,
- determinents, and
- regional variation,
of their comorbidities.
van Deursen VM et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Europ J Heart Fail. 2014;16:

3. Prevalence of comorbidities in heart failure
…the most prevalent being…
Chronic kidney disease
Anemia
Diabetes
COPD
Stroke
41%
74%
29%
29%
Proportion of HF patients suffering
from at least 1 comorbidity
15%
11%
The number of comorbidities increases with the severity of heart failure.
van Deursen VM et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Europ J Heart Fail. 2014;16:

4. Prognostic implications of comorbidities in heart failure
Prognostic implications of comorbidities are assessed by population attributable risks (PARs*), corresponding to the % of all-cause mortality in the population attributable to the comorbidity:
Chronic Kidney Disease
Anemia
Diabetes
COPD
41%
(95% CI, 29-51%)
37%
(95% CI, 27-46%)
14%
(95% CI, 5-–23%)
10%
(95% CI, 3-16%)
* “PAR can be described as the reduction in mortality that would be observed if the population was entirely unexposed to a certain c-morbidity,
compared with the mortality pattern in patients without that comorbidity”
van Deursen VM et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Europ J Heart Fail. 2014;16:

5. Determinents and regional variations of comorbidities in heart failure
Patients with comorbidities:
- older
- more advanced heart failure (reflected by a higher NYHA class)
- higher prevalence of hypertension and AF
although a causal relationship cannot be established based on the data.
- more comorbidities  more clinical signs of congestion (elevated JVP or peripheral oedema)
- less likely to be receiving evidence-based therapies, such as ACEis, ARBs, and β-blockers.
Patients with heart failure of ischemic aetiology had more comorbidities.
Across various European regions, there are marked differences in prevalence and prognostic implications of comorbidities.
Patients with increasing numbers of comorbidities have
an increasing risk of both mortality and heart failure hospitalization.
van Deursen VM et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Europ J Heart Fail. 2014;16: