COMORBIDITIES IN HEART FAILURE CAN GUIDE TREATMENT OPTIONS

Purpose: Heart failure (HF) accounts for a large morbidity burden. This study investigates the drivers of this burden.   

Method:   Encounter data were studied from state Medicaid Managed Care Organizations for 18-64 year old patients with a diagnosis of HF over 5 years ending in 6-30-10.  Exploratory models assessed the prevalence of COPD, CVD, stroke, and renal dysfunction, respectively and shown by age, race and gender, as diagnosed in HF patients within 3 months after HF diagnosis.

Result:  Of 14,149 HF patients, 36% were 45-54 years old (yo), 35% 55-64 yo and others under 45; 56% females, 60% African-Americans. Most had hypertension (11130). Diabetes (6369), COPD (4297 ), renal dysfunction (4012) and or stroke (3208) were major comorbidites.  HF Patients with renal dysfunction were younger (27% under 45), than counterparts with hypertension (25%), diabetes (20%), stroke (20%) and or COPD (16%).  Those with COPD were largely Caucasian (46%), while counterparts with hypertension (62%), renal dysfunction (66%), diabetes (60%) and or stroke (60%) were largely African American.  Except for renal dysfunction (48% female), most patients with COPD (60%), hypertension (62%), renal dysfunction (66%), diabetes (59%) and or stroke (55%) were females.

Conclusion: The prevalence of COPD, stroke, hypertension, diabetes and renal dysfunction in heart failure is high. Those comorbidities however affect HF patients differently according to race, age and gender, which calls for customized treatments for high risk but relatively younger, more diverse and female HF populations, typically under-represented in clinical trials.