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Background: Data regarding the impact of preheart failure (HF) comorbidities on the prognosis of HF are scarce, especially in the younger HF patients.Objectives: To investigate pre-existing comorbidities in HF patients versus matched controls and to assess their impact on mortality.Methods: We included all first-time in-hospital and outpatient diagnoses of HF from 1995 to 2017, and comorbidities antedating the HF-diagnosis in the Danish nationwide registries. HF patients were matched with up to five controls. One-year all-cause mortality rates and population attributable risk (PAR) were estimated for three separate age groups (≤50, 51-74 and >74 years).Results: Totally 280 002 patients with HF and 1 166 773 controls were included. Cardiovascular comorbidities, for example, cerebrovascular disease and ischaemic heart disease were more frequent in the oldest (17.9% and 29.7% in HF vs. 9.8% and 10.7% in controls) compared to the youngest age group (3.9% and 15.2% in HF vs. 0.7% and 0.9% in controls). Amongst patients with HF, 1-year mortality rates (per 100 person-years) were highest amongst those with >1 noncardiovascular comorbidity: ≤50 years (10.4; 9.64-11.3), 51-74 years (23.3; 22.9-23.7), >74 years (58.5; 57.9-59.0); hazard ratios 245.18 (141.45-424.76), 45.85 (42.77-49.15) and 24.5 (23.64-25.68) for those ≤50, 51-74 and >74 years, respectively. For HF patients ≤50 years, PAR was greatest for hypertension (17.8%), cancer (14.1%) and alcohol abuse (8.5%). For those aged >74 years, PAR was greatest for hypertension (23.6%), cerebrovascular disease (6.2%) and cancer (7.2%).Conclusions: Heart failure patients had a higher burden of pre-existing comorbidities, compared to controls, which adversely impacted prognosis, especially in the young. [ABSTRACT FROM AUTHOR]

Aims: We examined 30-year nationwide trends in heart failure hospitalization and mortality rates, and the prognostic impact of co-morbidity.Methods and Results: We conducted a population-based cohort study of 317 161 patients with first-time inpatient hospitalizations for heart failure during 1983-2012. We computed the standardized hospitalization rate and 5-year mortality risk. Co-morbidity levels and calendar periods of diagnosis were compared by means of mortality rate ratios (MRRs) based on Cox regression. The standardized hospitalization rate (per 100 000 persons) decreased between 1983 and 2012 by 25% for women (from 192 to 144) and by 14% for men (from 217 to 186). The decrease reflected an average annual 1% increase until 2000 and a 3.5% decline thereafter. Between 1983-1987 and 2008-2012, 1-year mortality declined from 45% to 33% and 1- to 5-year mortality from 59% to 43%. The decline occurred independently of patients' co-morbidity levels. Comparing 2008-2012 with 1983-1987, the 5-year age-, sex-, and co-morbidity-adjusted MRR was 0.57 [95% confidence interval (CI) 0.56-0.58]. Using low co-morbidity as reference, the adjusted 5-year MRR in 2003-2007 was increased by 43% for moderate, 66% for severe, and 2.2-fold for very severe co-morbidity. The magnitude of co-morbidity-associated mortality increased over time and was highest in the youngest patients.Conclusions: Hospitalization rates for heart failure have declined markedly since 2000 in Denmark. One- and five-year mortality declined >40% over the last three decades. The decline in mortality occurred for patients with all levels of co-morbidity, but co-morbidity burden was a strong prognostic factor. [ABSTRACT FROM AUTHOR]

Aims: With improvement in survival of chronic heart failure (HF), the clinical importance of co-morbidity is increasing. The aim of this study was to assess the incidence and risk of cancer and all-cause mortality in a large Danish HF cohort.Methods and Results: A total of 9307 outpatients with verified HF without a prior diagnosis of cancer (27% female, mean age 68 years, 89% with LVEF <45%) were included in the study. A diagnosis of any cancer and all-cause mortality was obtained from Danish national registries. Outcome was compared with the general Danish population. Overall and type-specific risk of cancer was analysed in an adjusted Poisson and Cox regression analysis. The 975 diagnoses of cancer in the HF cohort and 330 843 in the background population corresponded to incidence rates per 10 000 patient-years of 188.9 [95% confidence interval (CI) 177.2-200.6] and 63.0 (95% CI 63.0-63.4), respectively. When stratified by age, incidence rates were increased in all age groups in the HF cohort. Risk of any type of cancer was increased, with an incidence rate ratio of 1.24 (95% CI 1.15-1.33, c < 0.0001). Type-specific analysis demonstrated an increased hazard ratio for all major types of cancer except for prostate cancer. All-cause mortality was higher in HF patients with cancer compared with cancer patients from the background population.Conclusions: Patients with HF have an increased risk of cancer, which persists after the first year after the diagnosis of HF, and their prognosis is worse compared with that of cancer patients without HF. [ABSTRACT FROM AUTHOR]

Introduction: Hyperkalaemia (HK) defined as blood potassium (K+) >5.0 mmol/L is common among patients with chronic heart failure (CHF) and associated with adverse outcomes. Little is known about the characteristics of patients with repeated and persistent HK. Methods: Observational laboratory study of patients with a first CHF diagnosis in the total population (1.8 million) of Northern Denmark, 2000-2012. CHF was defined as discharge diagnosis of CHF with echocardiography and treatment with both renin angiotensin aldosterone system (RAAS) inhibitor and beta-blocker. For all CHF patients with an incident HK event, we examined K+ trajectories over the following 6 months. We described patient characteristics associated with persistent HK (2 or more elevated K+ tests >5.0 mmol/L with maximum 1 normal K+ test in between) and repeated HK (2 or more elevated K+ tests separated by ≥2 normal K+ tests). Results: In 14,318 patients with CHF (median age 74 years, 38% females, median annual K+ tests = 6), 39% (n=5,599) had a subsequent HK event detected. Within 6 months after the first HK, 31% (n=1,723) had died, 37% (n=2,070) had no additional high K+ value, while 32% (n=1,806) fell into a persistent or repeated HK pattern. FIGURE shows K+ trajectories for patients with persistent (A: 2 high K+ tests, n=548; B: 3 high tests, n=207; C: ≥4 high tests, n=167) or repeated HK (D: n=884). Important predictors for developing persistent or repeated HK (e.g., trajectory C in FIGURE) included severity of first HK event (prevalence ratio (PR)=4.13 (95% CI 2.13-8.03) for K+ 6.0-6.5 mmol/L), severity of kidney disease (PR=1.43 (95% CI 0.82-2.48) for eGFR <15 mL/min/1.73m2, PR=6.39 (95% CI 3.63-11.22) for dialysis), diabetes (PR=1.38 (95% CI 1.14-1.66), and spironolactone use (PR=1.23 (95% CI 1.09-1.38)). Conclusions: Repeated HK and persistently elevated K+ levels are common in CHF patients. The use of readily identifiable clinical predictors can help identify patients at highest risk, who can benefit most from effective K+ management. [ABSTRACT FROM AUTHOR]