The prevalence of heart failure (HF) and co-morbidities are increasing. The prognostic
impact of interaction between co-morbidity and HF remains unknown. The purpose of
the present study was to examine if HF interacts with co-morbidity burden to increase
mortality.
We conducted a cohort study of all adult Danish patients (aged ≥18 years) with a hospital
inpatient or outpatient clinic diagnosis of HF (n = 252,726) between 1995 and 2016.
We matched each patient with up to 3 members of the general population without a history
of HF (n = 744,372). Noncardiac co-morbidities were assessed using the Charlson co-morbidity
index and were defined by 4 categories of co-morbidity: 0 (none), 1 (low), 2 to 3
(moderate), and ≥4 (severe). Cardiac co-morbidities were assessed individually. Among
patients with HF with severe co-morbidity, 42% of the mortality rate during 30 days
of follow-up was explained by the interaction with co-morbidity. The interaction effect
was also substantial in patients with moderate (31%) and low co-morbidity burden (16%).
During 31 to 365 days of follow-up, interaction effects were 1% for low co-morbidity,
8% for moderate co-morbidity, and 22% for severe co-morbidity. Beyond 1 year of follow-up,
no interaction effect was observed. With the exception of cardiomyopathy, cardiac
co-morbidities did not interact substantially with HF during the first year of follow-up.
During longer follow-up, pulmonary hypertension, cardiomyopathy, and endocarditis
showed interaction. In conclusion, noncardiac co-morbidities had biological interaction
with HF that increased short-term mortality substantially beyond the individual effects
of HF and co-morbidity.
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Article Info
Publication History
Published online: July 19, 2022
Received in revised form:
May 24,
2022
Received:
March 7,
2022
Footnotes
This work was supported by the Department of Clinical Epidemiology, Aarhus University Hospital (Aarhus, Denmark).
See page 7 for disclosure information.
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