PT  - JOURNAL ARTICLE
AU  - Michael Drozd
AU  - Samuel D Relton
AU  - Andrew M N Walker
AU  - Thomas A Slater
AU  - John Gierula
AU  - Maria F Paton
AU  - Judith Lowry
AU  - Sam Straw
AU  - Aaron Koshy
AU  - Melanie McGinlay
AU  - Alexander D Simms
AU  - V Kate Gatenby
AU  - Robert J Sapsford
AU  - Klaus K Witte
AU  - Mark T Kearney
AU  - Richard M Cubbon
TI  - Association of heart failure and its comorbidities with loss of life expectancy
AID  - 10.1136/heartjnl-2020-317833
DP  - 2020 Nov 05
TA  - Heart
PG  - heartjnl-2020-317833
4099  - http://heart.bmj.com/content/early/2020/11/05/heartjnl-2020-317833.short
4100  - http://heart.bmj.com/content/early/2020/11/05/heartjnl-2020-317833.full
AB  - Objective Estimating survival can aid care planning, but the use of absolute survival projections can be challenging for patients and clinicians to contextualise. We aimed to define how heart failure and its major comorbidities contribute to loss of actuarially predicted life expectancy.Methods We conducted an observational cohort study of 1794 adults with stable chronic heart failure and reduced left ventricular ejection fraction, recruited from cardiology outpatient departments of four UK hospitals. Data from an 11-year maximum (5-year median) follow-up period (999 deaths) were used to define how heart failure and its major comorbidities impact on survival, relative to an age–sex matched control UK population, using a relative survival framework.Results After 10 years, mortality in the reference control population was 29%. In people with heart failure, this increased by an additional 37% (95% CI 34% to 40%), equating to an additional 2.2 years of lost life or a 2.4-fold (2.2–2.5) excess loss of life. This excess was greater in men than women (2.4 years (2.2–2.7) vs 1.6 years (1.2–2.0); p<0.001). In patients without major comorbidity, men still experienced excess loss of life, while women experienced less and were non-significantly different from the reference population (1 year (0.6–1.5) vs 0.4 years (−0.3 to 1); p<0.001). Accrual of comorbidity was associated with substantial increases in excess lost life, particularly for diabetes, chronic kidney and lung disease.Conclusions Comorbidity accounts for the majority of lost life expectancy in people with heart failure. Women, but not men, without comorbidity experience survival close to reference controls.