Patterns of comorbidity in older adults with heart failure: the Cardiovascular Research Network PRESERVE study

Abstract

Objectives: To examine whether the total burden of comorbidity and pattern of co-occurring conditions varies in individuals with heart failure (HF) with preserved left ventricular ejection fraction (LVEF) (HF-P) or HF with reduced LVEF (HF-R).

Design: Cross-sectional cohort study.

Setting: Four participating health plans within the National Heart, Lung, and Blood Institute-sponsored Cardiovascular Research Network.

Participants: All members aged 65 and older with HF based on hospital discharge and ambulatory visit diagnoses.

Measurements: Participants with a LVEF of 50% or greater were classified as having HF-P. Presence of cardiac and noncardiac comorbidities was obtained from health plan administrative databases.

Results: Of 23,435 individuals identified with HF and LVEF information, 53% (12,407) had confirmed HF-P (mean age 79.6; 60% female). More than three-quarters of the sample had three or more co-occurring conditions in addition to HF, and half had five or more cooccurring conditions. Participants with HF-P had a slightly higher burden of comorbidity than those with HF-R (mean 4.5 vs 4.4, P = .002). Patterns of how specific conditions co-occurred did not vary in participants with preserved or reduced systolic function.

Conclusion: There is a high degree of comorbidity and multiple morbidity in individuals with HF. The burden and pattern of comorbidity varies only slightly in individuals with preserved or reduced LVEF.

Figure 1. Degree of comorbidity and multi-morbidity in patients with heart failure

Legend: Note: EF: Ejection Fraction ^aAge and sex adjusted p<0.0001 when compared to Reduced EF ^aAdjusted for age and sex p< 0.05 when compared to Reduced EF ^bAdjusted for age and sex p<<0.0001 when compared to Reduced EF