Prognostic outcomes in heart failure based on simple severity criteria: Insights from the French national healthcare coverage database

Abstract

Introduction

Heart failure (HF) is a significant and severe health condition, ideally requiring severity-based management.

Objective

This study aimed to outline the prognosis of HF on a national scale, based on straightforward severity criteria.

Method

This comprehensive cohort study utilized the French national healthcare coverage database, including patients over 18 diagnosed with HF, or hospitalized for HF within the last five years, and alive in January 2020, followed until December 2022. Patients were classified into four groups by severity: 1- Not Hospitalized without loop diuretics (NoHFH/D−), 2- Not Hospitalized with loop diuretics (NoHFH/D+), 3- HF hospitalization more than a year ago (HFH > 1y), and 4- Hospitalization within the past year for HF (HFH < 1y). Outcomes were analyzed using adjusted Cox models.

Results

The final analysis included 655,919 patients (mean age 77.5 ± 13 years, 48% female), with a relatively balanced distribution between groups (respectively 23.8%, 28.3%, 27.6%, and 20.4% in NoHFH/D−, NoHFH/D+, HFH > 1Y, and HFH < 1Y groups). The predominant comorbidities were coronary artery disease (36%), atrial fibrillation (34%), diabetes (29%), and chronic respiratory diseases (25%), with prevalence increasing with HF severity. Mortality rates at one year were 8.0%, 14.8%, 17.2%, and 25.0%, and the risks of HF hospitalization or death within a year were 9.9%, 20.5%, 24.9%, and 37.6% for NoHFH/D−, NoHFH/D+, HFH > 1Y, and HFH < 1Y respectively. After adjusting for demographics, medical history, and baseline treatments, the risks of mortality and the combined outcome of death or HF hospitalization progressively increased across the groups (HR for death: 1.57, (1.55–1.60); 1.82, (1.80–1.85); 2.24, (2.20–2.27); and HR for the combined criterion: 1.74 (1.72–1.76), 2.11 (2.08–2.14), 2.70 (2.67–2.74) for NoHFH/D+, HFH > 1Y, and HFH < 1Y respectively, P < 0.0001 for all, using NoHFH/D− as a reference).

Conclusion

This national cohort analysis revealed that patient risk profiles significantly vary by HF hospitalization timing and loop diuretic use. The progressively increasing risk of mortality and combined HF hospitalization or death highlights the need for severity-adjusted management strategies.