The role of Charlson comorbidity index score in obese heart failure patients

Introduction: Chronic heart failure represents a major public health issue, which despite all the great thera-peutic and management advances, is associated with a high morbidity and mortality rate, at least in part due to the presence of multiple cardiovascular and non-car-diovascular comorbid conditions. Moreover, comorbi-dity brings particular challenges in the diagnosis and treatment of heart failure. Charlson Comorbidity Index score (CCI) is the most widely used comorbidity index. Objective: To assess the CCI score utility in obese heart failure patients.
Methods: The study sample consisted of 126 overwei-ght and obese (body mass index ≥25 kg/m2) patients, with a mean age of 70.45±9.12 years, 54.8% men, ho-spitalized for decompensated heart failure. We used the CCI to evaluate the severity of comorbidity with a score ranging from 1 (only heart failure present) to 30 (extensive comorbidity). Baseline characteristics, cli-nical presentation, laboratory data, echocardiographic parameters and in-hospital therapies were compared among heart failure patients divided into three groups: low CCI ≤2, moderate CCI 3-4 and high CCI ≥5 co-morbidity risk. Heart failure was defined according to 2016 ESC criteria. A multivariable analysis was perfor-med.
Results: The prevalence of comorbidities ranged from 15% for chronic pulmonary diseases, 34% for diabetes without chronic complications and 36% for peptic ul-cer disease. 50.8% of patients had a high CCI risk score and only 5.6% had a CCI ≤2. The CCI risk was not sig-nificantly different between patients with heart failure with reduced (<40%) – HFrEF, mid-range (40-49%) HFmrEF and preserved (≥50%) – HFpEF ejection fraction (EF) (p=0.068). Heart failure patients with low CCI score were younger (51.66±14.43) in comparison with those with moderate or high CCI score (p<0.001). CCI score negatively correlated with NT-proBNP va-lues in patients with HFmrEF (r=-0.448, p=0.009) and HFpEF (r=-0.273, p=0.043). There were no significant differences regarding atrial fibrillation development, systolic arterial hypertension values, obesity grade or echocardiographic findings, such as left ventricular di-astolic dysfunction, pulmonary hypertension, left ven-tricle dimensions or left atrial dilatation between the three groups, regardless of EF.
Conclusions: In our study heart failure was associated with a wide spectrum of comorbid conditions that play an important role in decision making and outcome. CCI score did not predict left ventricular ejection frac-tion or atrial fibrillation development, but NT-proBNP values were negatively correlated with CCI score in pa-tients with HFmrEF and HFpEF.


ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)