Multimorbidity in patients with acute heart failure across world regions and country income levels (REPORT-HF): a prospective, multicentre, global cohort study

Abstract

Multimorbidity (two or more comorbidities) is common in patients with heart failure. The reported prevalence of multimorbidity in patients with heart failure ranges between 43% and 98% and varies among geographical regions. Multimorbidity complicates guideline-directed pharmacological treatment and worsens prognosis. Additionally, comorbidities in heart failure are important drivers of poor health-related quality of life and hospitalisations. Previous reports on the effect of multimorbidity in heart failure included a limited number of countries, predominantly from western Europe, Asia, and North America or were based on populations participating in clinical trials, in which patients with comorbidities such as (severe) renal failure or cancer are commonly excluded. Patients with heart failure from lower-income regions report fewer comorbidities, but are at higher risk of mortality than patients from higher-income regions. This finding suggests regional differences in medical surveillance or the prognostic impact of multimorbidity. Contemporaneous representative data on multimorbidity from a global heart failure population, which are needed to quantify international differences, are scarce. Furthermore, the effect of multimorbidity on heart failure treatment and non-heart failure related therapies for comorbidities have not been systematically evaluated. Therefore, this analysis aimed to assess prevalence, prognostic effect, and implications for treatment of multimorbidity across world regions in the global prospective Registry to Assess Medical Practice and Longitudinal Observation for Treatment of Heart Failure (REPORT-HF) cohort study.