Association of heart failure and its comorbidities with loss of life expectancy.

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. 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. 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. 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.

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© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

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Competing interests: JG has received a research grant from Medtronic. KKW has received speaker fees from Medtronic, Livanova, St. Jude Medical, Pfizer, Bayer and BMS. MTK has received speaker fees from Merck, Novo Nordisk and unrestricted research awards from Medtronic. ADS has received speaker fees from Abbott, BMS, AstraZeneca, Bayer, Novartis, Boehringer Ingelheim and Servier. VKG has received speaker fees from Abbott and Novartis.