European Journal of Heart Failure (2014) 16, 103–111 doi:10.1002/ejhf.30

Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey Vincent M. van Deursen1, Renato Urso2, Cecile Laroche3, Kevin Damman1, Ulf Dahlström4, Luigi Tavazzi5, Aldo P. Maggioni6, and Adriaan A. Voors1,* 1 Department

of Cardiology, University of Groningen, Groningen, The Netherlands; 2 Pharmacology Unit ‘Giorgio Segre’, University of Siena, Siena, Italy; 3 EORP Department, ESC, Sophie Antipolis, France; 4 Department of Cardiology, Linkoping University Hospital, Linkoping, Sweden; 5 GVM Care and Research, Ettore Sansavini Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy; and 6 ANMCO Research Center, Florence, Italy

Received 27 March 2013; revised 6 June 2013; accepted 14 June 2013

Aims

Co-morbidities frequently accompany heart failure (HF), contributing to increased morbidity and mortality, and an impairment of quality of life. We assessed the prevalence, determinants, regional variation, and prognostic implications of co-morbidities in patients with chronic HF in Europe. ..................................................................................................................................................................... Methods A total of 3226 European outpatients with chronic HF were included in this analysis of the European Society of and results Cardiology (ESC) Heart Failure Pilot Survey. The following co-morbidities were considered: diabetes, hyper- and hypothyroidism, stroke, COPD, sleep apnoea, chronic kidney disease (CKD), and anaemia. Prognostic implications of co-morbidities were evaluated using population attributable risks (PARs), and patients were divided into geographic regions. Clinical endpoints were all-cause mortality and HF hospitalization. The majority of patients (74%) had a least one co-morbidity, the most prevalent being CKD (41%), anaemia (29%), and diabetes (29%). Co-morbidities were independently associated with higher age (P < 0.001), higher NYHA functional class (P < 0.001), ischaemic aetiology of HF (P < 0.001), higher heart rate (P = 0.011), history of hypertension (P < 0.001), and AF (P < 0.001). Only diabetes, CKD, and anaemia were independently associated with a higher risk of mortality and/or HF hospitalization. There were marked regional differences in prevalence and prognostic implications of co-morbidities. Prognostic implications of co-morbidities (PARs) were: CKD = 41%, anaemia = 37%, diabetes = 14%, COPD = 10%, and