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Am J Med. 2015 Jan;128(1):38-45. doi: 10.1016/j.amjmed.2014.08.024. Epub 2014 Sep 16.

Multimorbidity in heart failure: a community perspective.

Author information

1
Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
2
Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minn.
3
Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel.
4
Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Md.
5
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
6
Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Department of Neurology, Mayo Clinic, Rochester, Minn.
7
Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minn; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn. Electronic address: roger.veronique@mayo.edu.

Abstract

BACKGROUND:

Comorbidities are a major concern in heart failure, leading to adverse outcomes, increased health care utilization, and excess mortality. Nevertheless, the epidemiology of comorbid conditions and differences in their occurrence by type of heart failure and sex are not well documented.

METHODS:

The prevalence of 16 chronic conditions defined by the US Department of Health and Human Services was obtained among 1382 patients from Olmsted County, Minn. diagnosed with first-ever heart failure between 2000 and 2010. Heat maps displayed the pairwise prevalences of the comorbidities and the observed-to-expected ratios for occurrence of morbidity pairs by type of heart failure (preserved or reduced ejection fraction) and sex.

RESULTS:

Most heart failure patients had 2 or more additional chronic conditions (86%); the most prevalent were hypertension, hyperlipidemia, and arrhythmias. The co-occurrence of other cardiovascular diseases was common, with higher prevalences of co-occurring cardiovascular diseases in men compared with women. Patients with preserved ejection fraction had one additional condition compared with those with reduced ejection fraction (mean 4.5 vs 3.7). The patterns of co-occurring conditions were similar between preserved and reduced ejection fraction; however, differences in the ratios of observed-to-expected co-occurrence were apparent by type of heart failure and sex. In addition, some psychological and neurological conditions co-occurred more frequently than expected.

CONCLUSION:

Multimorbidity is common in heart failure, and differences in co-occurrence of conditions exist by type of heart failure and sex, highlighting the need for a better understanding of the clinical consequences of multiple chronic conditions in heart failure patients.

KEYWORDS:

Comorbidity; Heart failure; Multimorbidity

PMID:
25220613
PMCID:
PMC4282820
DOI:
10.1016/j.amjmed.2014.08.024
[Indexed for MEDLINE]
Free PMC Article

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