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Non-CV comorbidities often ignored when treating HF
Pathways between CV and non-CV comorbidities in patients with HF were not affected by treatments for HF, according to a study published in PLOS Medicine.
“This study highlights the lack of understanding about the relationship among different comorbidities and the quality of life for patients with heart failure,” Claire A. Lawson, Wellcome-Trust fellow and lecturer at University of Leicester in England, said in a press release. “It demonstrates the importance to develop guidance for the use of an individualized treatment approach for these patients.”
Swedish patients with HF
Researchers analyzed poor health-rated quality-of-life data, patient demographics and health care and clinical information from 10,575 patients (median age, 74 years; 33% women) with HF from the Swedish HF Registry from Feb. 1, 2008, to Nov. 1, 2013. Patients were either admitted to the hospital or attended outpatient clinics.
Quality-of-life data were measured at baseline through the EuroQol-5 dimension questionnaire, which included the EuroQol visual analogue scale. The scale ranged from 0, which was worst health, to 100, signifying best health.
Mean EuroQol visual analogue scale progressively decreased in patients with no comorbidities (mean score, 66), to those with CV comorbidities (mean score, 62) and to those with non-CV comorbidities (mean score, 59).
The link between atrial fibrillation and patient-rated health was explained through an increased risk for depression or anxiety (OR = 1.16; 95% CI, 1.06-1.27). This was also seen for ischemic heart disease (OR = 1.2; 95% CI, 1.09-1.32). Pain contributed to the link between ischemic heart disease and patient-rated health (OR = 1.25; 95% CI, 1.14-1.38).
Compared with patients with HF without diabetes and chronic kidney disease, those with the two conditions were more likely to have marked or severe shortness of breath (OR for diabetes = 1.17; 95% CI, 1.03-1.32; OR for chronic kidney disease = 1.23; 95% CI, 1.1-1.38) and fatigue (OR for diabetes = 1.27; 95% CI, 1.13-1.42; OR for chronic kidney disease = 1.24; 95% CI, 1.12-1.38, respectively). Chronic obstructive pulmonary disease was also associated with shortness of breath (OR = 1.84; 95% CI, 1.62-2.1) and fatigue (OR = 1.69; 95% CI, 1.5-1.91).
Direct associations were seen between patient-rated health and all symptoms. There were also indirect associations through functional limitations.
Effects on health, function
Depression or anxiety had the strongest association with patient-rated health (mean difference in EuroQol visual analogue scale score = –18.68; 95% CI, –23.22 to –14.14) and functional limitations (OR = 10.03; 95% CI, 5.16-19.5). These associations were not influenced by HF-optimizing therapies.
“Our findings show that a potential mismatch exists between these guidelines and patient-rated health, with increased [shortness of breath] and fatigue being driven by non-cardiovascular status and pain, and anxiety or depression being driven by cardiovascular status,” Lawson and colleagues wrote. “This indicates that, for HF patients’ health to improve, new interventions for common HF symptoms need to include the most prevalent non-cardiovascular comorbidities and that management of pain and anxiety or depression needs to become part of routine guideline-driven care and would be an important addition to clinically relevant endpoints in clinical trials.” – by Darlene Dobkowski
Disclosures: Lawson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.