Prevalence and prognosis of multimorbidity in heart failure with mildly reduced ejection fraction

BACKGROUND AND OBJECTIVE: Related to ongoing demographic, the number of patients with cardiac and non-cardiac comorbidities increases. Heart failure with mildly reduced ejection fraction (HFmrEF) represents a heterogeneous population with diverse clinical profiles. The study investigates the prevalence and prognostic impact of multimorbidity in patients hospitalized with HFmrEF. METHODS: Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022 and divided into four groups based on the number of concomitant comorbidities taking into account 12 comorbidities (i.e., 0-1, 2-3, 4-5, ≥ 6 comorbidities). The prognostic impact of the number of comorbidities was investigated with regard to the primary endpoint all-cause mortality at 30 months. RESULTS: From 2,184 patients hospitalized with HFmrEF, 37% presented with 4-5 comorbidities, 17% with ≥ 6 comorbidities. Compared to patients with 4-5, 2-3, 0-1 comorbidities, patients with ≥ 6 comorbidities were more frequently discharged with beta-blockers (83.6% vs. 78.7% vs. 77.6% vs. 64.7%; p = 0.001) and mineralocorticoid receptor antagonists (MRA) (17.2% vs. 15.7% vs. 12.8% vs. 7.9%; p = 0.004). The risk of all-cause mortality at 30 months was higher in patients with ≥ 6 comorbidities compared to patients with less comorbidities (i.e., 4-5, 2-3, 0-1) (59.5% vs. 38.6% vs. 17.0% vs. 7.9%, p = 0.001). Both cardiovascular (HR = 1.106; 95% CI 1.030 - 1.188; p = 0.006) and non-cardiovascular (HR = 1.564; 95% CI 1.470 - 1.664; p = 0.001) comorbidities predicted the risk of long-term all-cause mortality. CONCLUSION: In patients hospitalized with HFmrEF, more than 50% had at least 4 comorbidities. Both cardiovascular and non-cardiovascular comorbidities predicted the risk of long-term all-cause mortality in HFmrEF.