Heart failure & cardiomyopathiesCohort study
Association of Charlson Comorbidity Index with Clinical Characteristics and Outcomes in Heart Failure
- registry study
- Swedish heart failure (HF) registry
- multivariable multinominal and Cox regressions
Authors' conclusion
The ACCI discriminates well in HF, with higher ACCI being associated with greater severity of HF, lesser GDMT use and worse quality of life. Higher ACCI was more strongly associated with death than hospitalization. Higher ACCI was more strongly associated with non-CV outcomes but also with CV and HF outcomes.
Study context
- Population
- Patients with heart failure in the Swedish HF registry
- Participants
- 117,419 patients
- Exposure
- intermediate and high vs low ACCI
Main finding
As reported in the abstract
Composite CV mortality/first HF hospitalization · up to 3 years
Each group vs low ACCIAdjusted hazard ratio (95% CI)
intermediate ACCI
1.34(1.29–1.39)
high ACCI
1.76(1.69–1.83)
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| Non-CV mortality | adjusted HR 6.36 (95% CI 5.75–7.04) | |
| CV mortality | HR 4.35 (CI 3.99–4.74) | |
| Total hospitalizations | adjusted IRR 2.16 (CI 2.11–2.22) | |
| 0.10.31310Ratio (log scale) |
| Outcome | Estimate |
|---|---|
| HF hospitalizations | 1.23 (CI 1.17–1.28) |
Median ACCI by ejection fraction (EF) category
- Median ACCI in HFrEF (53% of patients)
- 5
- Median ACCI in HFmrEF (24% of patients)
- 6
- Median ACCI in HFpEF (23% of patients)
- 6
- ACCI ≥7 in HFrEF
- 31%
- ACCI ≥7 in HFmrEF
- 35%
- ACCI ≥7 in HFpEF
- 42%
Clinical characteristics and guideline-directed medical therapy (GDMT) use
- Higher ACCI associated with higher EF category, NYHA class, serum NT-proBNP, diuretic use, and lower quality of life and GDMT use
- P < 0.05 for all
Original publication
Association of Charlson Comorbidity Index with Clinical Characteristics and Outcomes in Heart Failure. ESC Heart Fail. Published 19 July 2026. doi:10.1093/eschf/xvag165
Summarised from the published abstract; every number is checked against it