Comorbidity profiles and inpatient outcomes during hospitalization for heart failure: an analysis of the U.S. Nationwide inpatient sample

Abstract

Background: Treatment of heart failure (HF) is particularly complex in the presence of comorbidities. We sought to identify and associate comorbidity profiles with inpatient outcomes during HF hospitalizations.

Methods: Latent mixture modeling was used to identify common profiles of comorbidities during adult hospitalizations for HF from the 2009 Nationwide Inpatient Sample (n = 192,327).

Results: Most discharges were characterized by "common" comorbidities. A "lifestyle" profile was characterized by a high prevalence of uncomplicated diabetes, hypertension, chronic pulmonary disorders and obesity. A "renal" profile had the highest prevalence of renal disease, complicated diabetes, and fluid and electrolyte imbalances. A "neurovascular" profile represented the highest prevalence of cerebrovascular disease, paralysis, myocardial infarction and peripheral vascular disease. Relative to the common profile, the lifestyle profile was associated with a 15% longer length of stay (LOS) and 12% greater cost, the renal profile was associated with a 30% higher risk of death, 27% longer LOS and 24% greater cost, and the neurovascular profile was associated with a 45% higher risk of death, 34% longer LOS and 37% greater cost (all p < 0.001).

Conclusions: Comorbidity profiles are helpful in identifying adults at higher risk of death, longer length of stay, and accumulating greater costs during hospitalizations for HF.

Figure 1

Prevalence of comorbidities in adult hospitalizations with a principal diagnosis of heart failure. Prevalence estimates were generated using discharge weights (n = 192,327; population estimate n = 976,664). Only conditions with a prevalence of 5% or greater are displayed for economy of presentation.

Figure 2

Four observed comorbidity profiles in adult hospitalizations with a principal diagnosis of heart failure. Radar graphs present within-profile prevalence of differentiating comorbidities from 0% (center of graph) to 100% (outside of graph). The common profile (A) had the lowest prevalence of cerebrovascular disease, myocardial infarction, peripheral vascular disorders, depression, renal disease, fluid and electrolyte disorders, hypertension, and obesity compared with the other profiles. Key attributes of the lifestyle profile (B) were high rates of uncomplicated diabetes, hypertension, chronic pulmonary disorders and obesity. Key attributes of the renal profile (C) were high rates of renal disease, diabetes with complications and fluid and electrolyte imbalances. Key attributes of the neurovascular profile (D) were high rates of cerebrovascular disease, paralysis, myocardial infarction, peripheral vascular disease, neurological disorders and depression. Prevalence estimates were generated using discharge weights (n = 192,327; population estimate n = 976,664). All differences by comorbidity profile were statistically significant (all p < 0.0001).