Background: The increase in medical complexity among patients hospitalized with heart failure (HF) may be reflected by an increase in concomitant noncardiovascular comorbidities. Among patients hospitalized with HF, the temporal trends in the prevalence of noncardiovascular comorbidities have not been well described.

Methods and Results: We used data from 207 984 patients in the Get With The Guidelines–Heart Failure registry (from 2005 to 2014) to evaluate the prevalence and trends of noncardiovascular comorbidities (chronic obstructive pulmonary disorder/asthma, anemia, diabetes mellitus, obesity [body mass index ≥30 kg/m²], and renal impairment) among patients hospitalized with HF. Medicare beneficiaries aged ≥65 years were used to assess 30-day mortality. The prevalence of 0, 1, 2, and ≥3 noncardiovascular comorbidities was 18%, 30%, 27%, 25%, respectively. From 2005 to 2014, there was a decline in patients with 0 noncardiovascular comorbidities (22%–16%; P<0.0001) and an increase in patients with ≥3 noncardiovascular comorbidities (18%–29%; P<0.0001). Among Medicare beneficiaries, there was an increased 30-day adjusted mortality risk among patients with 1 noncardiovascular comorbidity (hazard ratio, 1.16; 95% confidence interval, 1.09–1.24; P<0.0001), 2 noncardiovascular comorbidities (hazard ratio, 1.34; 95% confidence interval, 1.25–1.44; P<0.0001), and ≥3 noncardiovascular comorbidities (hazard ratio, 1.63; 95% confidence interval, 1.51–1.75; P<0.0001). Similar trends were seen for in-hospital mortality.

Conclusions: Patients admitted in hospital for HF have an increasing number of noncardiovascular comorbidities over time, which are associated with worse outcomes. Strategies addressing the growing burden of noncardiovascular comorbidities may represent an avenue to improve outcomes and should be included in the delivery of in-hospital HF care.

背景：心力衰竭（HF）住院患者的医疗复杂性增加可能反映在伴随的非心血管合并症增加上。在住院的HF患者中，非心血管合并症的流行趋势没有得到很好的描述。

方法和结果：我们使用“获取指导原则-心力衰竭”登记册（2005年至2014年）中207 984名患者的数据来评估非心血管合并症（慢性阻塞性肺疾病/哮喘，贫血，糖尿病，肥胖症）的患病率和趋势HF患者中[体重指数≥30kg / m ² ]和肾功能不全。年龄≥65岁的Medicare受益人用于评估30天死亡率。0、1、2和≥3的非心血管合并症的患病率分别为18％，30％，27％，25％。从2005年到2014年，非心血管合并症0例患者下降（22％–16％；P <0.0001），≥3非心血管疾病合并症患者增加（18％–29％; P<0.0001）。在Medicare受益人中，患有1例非心血管合并症（风险比，1.16； 95％置信区间，1.09–1.24；P <0.0001），2例非心血管合并症的患者，30天调整后死亡风险增加。 ％置信区间1.25–1.44；P <0.0001）和≥3的非心血管合并症（危险比1.63； 95％置信区间1.51-1.75；P <0.0001）。院内死亡率也有类似趋势。

结论：随着时间的流逝，因心力衰竭住院的患者的非心血管合并症数量不断增加，这与预后差有关。解决非心血管合并症日益严重的负担的策略可能代表改善结局的途径，应纳入医院HF治疗中。