Multimorbidity Burden and Adverse Outcomes in a Community-Based Cohort of Adults with Heart Failure
Authors
Tisminetzky, MayraGurwitz, Jerry H.
Fan, Dongjie
Reynolds, Kristi
Smith, David H.
Magid, David J.
Sung, Sue Hee
Murphy, Terrence E.
Goldberg, Robert J.
Go, Alan S.
UMass Chan Affiliations
Department of Quantitative Health SciencesDivision of Geriatric Medicine, Department of Medicine
Meyers Primary Care Institute
Document Type
Journal ArticlePublication Date
2018-09-24Keywords
comorbidityheart failure
multimorbidity
multiple chronic conditions
Cardiovascular Diseases
Epidemiology
Geriatrics
Health Services Administration
Health Services Research
Metadata
Show full item recordAbstract
OBJECTIVES: To assess multimorbidity burden and its association with clinical outcomes in adults with heart failure (HF) according to sex, age, and HF type. DESIGN: Retrospective cohort study. SETTING: Five healthcare delivery systems across the United States. PARTICIPANTS: Adults with HF (N=114,553). MEASUREMENTS: We characterized participants with respect to the presence of 26 chronic conditions categorized into quartiles based on overall burden of comorbidity ( < 5, 5-6, 7-8, > /=9). Outcomes included all-cause death and hospitalization for HF or any cause. Multivariable Cox regression was used to evaluate the adjusted association between categorized burden of multimorbidity burden and outcomes. RESULTS: Individuals with more morbidities were more likely to die than those with fewer then 5 morbidities (5-6 morbidities: adjusted hazard ratio (aHR)=1.27 (95% confidence interval (CI)=1.24-1.31; 7-8 morbidities: aHR=1.52, 95% CI=1.48-1.57; > /=9 morbidities: aHR=1.92, 95% CI=1.86-1.99). There was a graded, higher adjusted rate of any-cause hospitalization associated with 5 or 6 (aHR=1.28, 95% CI=1.25-1.30), 7 or 8 (aHR=1.47, 95% CI=1.44-1.50), or 9 or more (aHR=1.77, 95% CI=1.73-1.82) morbidities (vs < 5). Similar findings were observed for HF-specific hospitalization in those with 5 or 6 (aHR=1.22, 95% CI=1.19-1.26), 7 or 8 (aHR=1.39, 95% CI=1.34-1.44), or 9 or more (aHR 1.68, 95% CI=1.61-1.74) morbidities (vs < 5). Consistent findings were seen according to sex, age group, and HF type (preserved, reduced, borderline HF), in the association between categorical burden of multimorbidity and outcomes especially prominent in individuals younger than 65. CONCLUSION: After adjustment, higher levels of multimorbidity predicted worse HF outcomes and may be an important consideration in strategies to improve clinical and person-centered outcomes.Source
J Am Geriatr Soc. 2018 Sep 24. doi: 10.1111/jgs.15590. [Epub ahead of print] Link to article on publisher's site
DOI
10.1111/jgs.15590Permanent Link to this Item
http://hdl.handle.net/20.500.14038/46761PubMed ID
30246862Related Resources
ae974a485f413a2113503eed53cd6c53
10.1111/jgs.15590