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 - 2021 Sep 01 TA - Heart PG - 1417--1421 VI - 107 IP - 17 4099 - http://heart.bmj.com/content/107/17/1417.short 4100 - http://heart.bmj.com/content/107/17/1417.full SO - Heart2021 Sep 01; 107 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.Data are available on reasonable request. The datasets generated and/or analysed during the current study are not publicly available due to inclusion of potentially identifying postal codes, but are available from the corresponding author on reasonable request.