2014


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2014/№5

Comorbidity and prognosis in patients with chronic heart failure

Efremova E. V., Shutov A. M.
Ulyanovsk State University, L. Tolstoy 42, Ulyanovsk, 432017

Keywords: comorbidity, prognosis, CHF


DOI: 10.18087 / rhfj.2014.5.2011

Background. A characteristic feature of current therapy and diagnostics for chronic diseases, including CHF, is the presence of a combination of several conditions in a patient, i.e., comorbidity. Aim. To study the predictive significance of comorbidity in patients with CHF. Materials and methods. 203 patients (130 males and 73 females; mean age, 61.8±9.6) with CHF were followed up for 12 months. Comorbidity and effects of comorbidity on death rate and number and duration of hospitalizations were evaluated. Results. The Charlson comorbidity index (CCI) was 5.0±2.1. The most frequent component of comorbidity structure was chronic kidney disease (CKD) which was observed in 44 % of CHF patients (chronic cardiorenal syndrome). Patients with high comorbidity were characterized by more severe CHF and higher incidence of atrial fibrillation. Presence of comorbidity results in increased incidence of all-cause death; relative risk of death for 12 months was 1.68 times higher (95 % CI 1.35–2.09) in the high comorbidity group than in the low comorbidity group. Mean annual duration of all-cause hospitalizations was 5 days longer and duration of hospitalizations for CHF exacerbation was 3 days longer in CHF patients with high comorbidity. Conclusion. Presence of high comorbidity considerably affects the prognosis of CHF patients. Higher comorbidity is associated with increased relative risk of death and number and duration of hospitalizations both for all causes and for CHF exacerbation.
  1. Мареев В. Ю., Агеев Ф. Т., Арутюнов Г. П., Коротеев А. В., Ревишвили А. Ш. Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (третий пересмотр). Журнал Сердечная Недостаточность. 2010;11 (1):3–62.
  2. McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012; Jul33 (14):1787–1847.
  3. Беленков Ю. Н., Мареев В. Ю., Агеев Ф. Т. и др Истинная распространенность ХСН в Европейской части Российской Федерации. Журнал Сердечная недостаточность. 2011;12 (2):63–8.
  4. Uijen A, van de Lisdonk EH. Multimorbidity in primary care: pre­valence and trend over the last 20 years. Eur J Gen Practice. 2008;14 (Suppl 1):28–32.
  5. Fortin M, Stewart M, Poitras ME et al. A systematic review of prevalence studies on multimorbidity: Toward a more uniform methodology. Ann Fam Med. 2012 Mar;10 (2):142–51.
  6. Bayliss EA, Steiner JF, Fernald DH et al. Description of barriers to self-care by persons with comorbid chronic diseases. Ann Fam Med. 2003 May;1 (1):15–21.
  7. Dickson VV, Buck H, Riegel B. A qualitative meta-analysis of heart failure self-care practices among individuals with multiple comorbid conditions. J Cardiac Fail. 2011 May;17 (5): 413–9.
  8. Piccirillo J, Tierney RM, Costas I et al. Prognostic importance of comorbidity in a hospital based cancer registry. J Am Med Ass. 2004 May 26;291 (20):2441–7.
  9. Dunlay SM, Weston SA, Killian JM et al. Thirty-day rehospitalizations after acute myocardial infarction: a cohort study. Ann Int Med. 2012 Jul 3;157 (1):11–8.
  10. Starfield B. Global health, equity, and primary care. J Am Board Fam Med. 2007 Nov;20 (6):511–3.
  11. Белялов Ф. И. Лечение внутренних болезней в условиях коморбидности. – Иркутск: «РИО ИГИУВа», 2012. – 285 с.
  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40 (5):373–383.
  13. Huntley AL, Johnson R, Purdy S et al. Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med. 2012 Mar;10 (2):134–41.
  14. Вёрткин А. Л., Петрик Е. А., Аристархова О. А. Полиморбид­ность – причина диагностических ошибок и расхождения клинического и морфологического диагноза. Врач скорой помощи. 2012;4 63–6.
  15. Смирнов А. В., Шилов Е. М., Добронравов В. А. и др. Националь­ные рекомендации. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению. Клиническая нефрология. 2012;4:4–26.
  16. Вёрткин А. Л., Скотников А. С. Коморбидность. Лечащий Врач. 2013;6:66–8.
  17. Marengoni A, Angleman S, Melis R et al. Ageing with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011 Sep;10 (4):430–9.
  18. Carmona M, García-Olmos LM, Alberquilla A et al. Heart failure in the family practice: a study of prevalence and co-morbidity. Fam Pract. 2011;28 (2):128–33.
  19. Van Deursen VM, Urso R, Laroche C et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail. 2014 Jan;16 (1):103–11.
  20. Van der Wel MC, Jansen RW, Bakx JC et al. Non-cardiovascular co-morbidity in elderly patients with heart failure outnumbers cardiovascular co-morbidity. Eur J Heart Fail. 2007 Jun;9 (6-7):709–15.
  21. Серов В. А., Шутов А. М., Мензоров М. В. и др. Эпидемиология хронической болезни почек у больных с хронической сердечной недостаточностью. Нефрология. 2010;14 (1):50–5.
  22. Lang CC, Mancini DM. Non-cardiac comorbidities in chronic heart failure. Heart. 2007 Jun;93 (6):665–71.
  23. Макеева Е. Р., Шутов А. М., Серов В. А. и др. Хроническая болезнь почек влияет на прогноз и стоимость стационарного лечения больных с хронической сердечной недостаточностью. Нефрология.2010;14 (2):51–5.
  24. MacDonald MR, Petrie MC, Hawkins NM et al. Diabetes, left ventricular systolic dysfunction, and chronic heart failure. Eur Heart J. 2008 May;29 (10):1224–40.
  25. De Groote P, Lamblin N, Mouquet F et al. Impact of diabetes mellitus on long-term survival in patients with congestive heart failure. Eur Heart J. 2004 Apr;25 (8):656–62.
  26. Стронгин Л. Г., Починка И. Г., Конышева М. С., Морозова Е. П. Гликемический контроль и течение хронической сердечной недостаточности у больных сахарным диабетом 2 типа. Сахарный Диабет. 2012;2:17–21.
  27. Напалков Д. А., Панферов А. С., Воронкина А. В. и др. Распро­страненность и структура анемий у пациентов с хронической сердечной недостаточностью в терапевтическом стационаре. Кардиология. 2009;49 (4):37–9.
  28. McManus DD, Hsu G, Sung SH et al. Atrial fibrillation and outcomes in heart failure with preserved versus reduced left ventricular ejection fraction. J Am Heart Ass. 2013 Feb;2 (1):e005694.
Efremova E. V., Shutov A. M. Comorbidity and prognosis in patients with chronic heart failure. Russian Heart Failure Journal. 2014;15 (5): 294–300

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