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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Impact of multimorbidity on mortality in heart failure with reduced ejection fraction: which comorbidities matter most? An analysis of PARADIGM-HF and ATMOSPHERE
European Journal of Heart Failure, Volume 25, No. 5, Year 2023
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Description
Aims: Multimorbidity, the coexistence of two or more chronic conditions, is synonymous with heart failure (HF). How risk related to comorbidities compares at individual and population levels is unknown. The aim of this study is to examine the risk related to comorbidities, alone and in combination, both at individual and population levels. Methods and results: Using two clinical trials in HF – the Prospective comparison of ARNI (Angiotensin Receptor–Neprilysin Inhibitor) with ACEI (Angiotensin-Converting Enzyme Inhibitor) to Determine Impact on Global Mortality and morbidity in HF trial (PARADIGM-HF) and the Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure trials (ATMOSPHERE) – we identified the 10 most common comorbidities and examined 45 possible pairs. We calculated population attributable fractions (PAF) for all-cause death and relative excess risk due to interaction with Cox proportional hazard models. Of 15 066 patients in the study, 14 133 (93.7%) had at least one and 11 867 (78.8%) had at least two of the 10 most prevalent comorbidities. The greatest individual risk among pairs was associated with peripheral artery disease (PAD) in combination with stroke (hazard ratio [HR] 1.73; 95% confidence interval [CI] 1.28–2.33) and anaemia (HR 1.71; 95% CI 1.39–2.11). The combination of chronic kidney disease (CKD) and hypertension had the highest PAF (5.65%; 95% CI 3.66–7.61). Two pairs demonstrated significant synergistic interaction (atrial fibrillation with CKD and coronary artery disease, respectively) and one an antagonistic interaction (anaemia and obesity). Conclusions: In HF, the impact of multimorbidity differed at the individual patient and population level, depending on the prevalence of and the risk related to each comorbidity, and the interaction between individual comorbidities. Patients with coexistent PAD and stroke were at greatest individual risk whereas, from a population perspective, coexistent CKD and hypertension mattered most. © 2023 European Society of Cardiology.
Authors & Co-Authors
Ferreira, João Pedro
Portugal, Porto
Universidade do Porto
Butt, Jawad Haider
United Kingdom, Glasgow
University of Glasgow
Denmark, Copenhagen
Rigshospitalet
Abraham, William T.
United States, Columbus
The Ohio State University
Desai, Akshay Suvas
United States, Boston
Brigham and Women's Hospital
Dickstein, Kenneth
Norway, Bergen
Universitetet I Bergen
Köber, Lars Valeur
Denmark, Copenhagen
Rigshospitalet
Packer, Milton P.
United States, Dallas
Baylor University Medical Center at Dallas
Rouleau, Jean Lucien
Canada, Montreal
University of Montreal
Stewart, Simon D.
Australia, Fremantle
The University of Notre Dame Australia
Swedberg, Karl B.
Sweden, Gothenburg
Göteborgs Universitet
Zile, Michael R.
United States, Charleston
Ralph H. Johnson va Medical Center
Solomon, Scott David
United States, Boston
Brigham and Women's Hospital
Jhund, Pardeep S.
United Kingdom, Glasgow
University of Glasgow
McMurray, John Joseph Valentine
United Kingdom, Glasgow
University of Glasgow
Statistics
Citations: 1
Authors: 14
Affiliations: 11
Identifiers
Doi:
10.1002/ejhf.2856
ISSN:
13889842
Research Areas
Environmental
Health System And Policy
Noncommunicable Diseases
Study Design
Cross Sectional Study
Cohort Study