Clinical Research in Cardiology

, Volume 107, Issue 6, pp 487–497 | Cite as

The contribution of comorbidities to mortality in hospitalized patients with heart failure

  • Oliver Riedel
  • C. Ohlmeier
  • D. Enders
  • A. Elsässer
  • D. Vizcaya
  • A. Michel
  • S. Eberhard
  • N. Schlothauer
  • J. Berg
  • E. Garbe
Original Paper



Heart failure (HF) with reduced ejection fraction (HFrEF) has a worse prognosis than HF with preserved EF (HFpEF). The study aimed to evaluate whether different comorbidity profiles of HFrEF- and HFpEF-patients or HF-specific mechanisms contribute to a greater extent to this difference.


We linked data from two health insurances to data from a cardiology clinic hospital information system. Patients with a hospitalization with HF in 2005–2011, categorized as HFrEF (EF < 45%) or HFpEF (EF ≥ 45%), were propensity score (PS) matched to controls without HF on comorbidites and medication to assure similar comorbidity profiles of patients and their respective controls. The balance of the covariates in patients and controls was compared via the standardized difference (SDiff). Age-standardized 1-year mortality rates (MR) with 95% confidence intervals (CI) were calculated.


777 HFrEF-patients (1135 HFpEF-patients) were PS-matched to 3446 (4832) controls. Balance between patients and controls was largely achieved with a SDiff < 0.1 on most variables considered. The age-standardized 1-year MRs per 1000 persons in HFrEF-patients and controls were 267.8 (95% CI 175.9–359.8) and 86.1 (95% CI 70.0–102.3). MRs in HFpEF-patients and controls were 166.2 (95% CI 101.5–230.9) and 61.5 (95% CI 52.9–70.1). Thus, differences in MRs between patients and their controls were higher for HFrEF (181.7) than for HFpEF (104.7).


Given the similar comorbidity profiles between HF-patients and controls, the higher difference in mortality rates between HFrEF-patients and controls points more to HF-specific mechanisms for these patients, whereas for HFpEF-patients a higher contribution of comorbidity is suggested by our results.


Heart failure Mortality Claims data Comorbidities 



The authors are grateful to the statutory health insurances AOK Bremen/Bremerhaven and AOK Niedersachsen for contributing data to the study. This study was supported by Bayer AG, Germany.

Compliance with ethical standards

Conflict of interest

A Michel and D Vizcaya are full-time employees of Bayer AG. J. Berg is a full-time employee of the statutory health insurance AOK Bremen/Bremerhaven. S. Eberhard is full-time employee of the statutory health insurance AOK Niedersachsen. O. Riedel, D. Enders, N. Schlothauer, A. Elsässer and C. Ohlmeier have nothing to disclose.

Supplementary material

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Supplementary material 1 (DOCX 30 KB)
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Supplementary material 3 (DOCX 32 KB)
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Supplementary material 4 (DOCX 29 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Leibniz Institute for Prevention Research and Epidemiology - BIPSBremenGermany
  2. 2.IGES Institut GmbHBerlinGermany
  3. 3.Department of CardiologyKlinikum Oldenburg, AöROldenburgGermany
  4. 4.EpidemiologyBayer AGBerlinGermany
  5. 5.AOK NiedersachsenHanoverGermany
  6. 6.Hausarztpraxis Dr. Stephan Spiekermann&Partner im GesundheitszentrumDelmenhorstGermany
  7. 7.AOK Bremen/BremerhavenBremerhavenGermany

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