Multimorbidity Burden and Adverse Outcomes in a Community-Based Cohort of Adults with Heart Failure

Mayra Tisminetzky; Jerry H Gurwitz; Dongjie Fan; Kristi Reynolds; David H Smith; David J Magid; Sue Hee Sung; Terrence E Murphy; Robert J Goldberg; Alan S Go

doi:10.1111/jgs.15590

Multimorbidity Burden and Adverse Outcomes in a Community-Based Cohort of Adults with Heart Failure

J Am Geriatr Soc. 2018 Dec;66(12):2305-2313. doi: 10.1111/jgs.15590. Epub 2018 Sep 24.

Authors

Mayra Tisminetzky^{1

2

3}, Jerry H Gurwitz^{1

2

3}, Dongjie Fan⁴, Kristi Reynolds⁵, David H Smith⁶, David J Magid⁷, Sue Hee Sung⁴, Terrence E Murphy⁸, Robert J Goldberg^{1

3}, Alan S Go^{4

9

10

11}

Affiliations

¹ Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.
² Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
³ Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
⁴ Division of Research, Kaiser Permanente Northern California, Oakland, California.
⁵ Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
⁶ Center for Health Research, Kaiser Permanente Northwest, Oregon, Portland.
⁷ The Kaiser Institute for Health Research Denver, Denver, Colorado.
⁸ Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
⁹ Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
¹⁰ Departments of Medicine, University of California, San Francisco, San Francisco, California.
¹¹ Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California.

Abstract

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. J Am Geriatr Soc 66:2305-2313, 2018.

Keywords: comorbidity; heart failure; multimorbidity; multiple chronic conditions.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Aged
Cause of Death
Chronic Disease*
Female
Heart Failure / epidemiology*
Hospitalization
Humans
Independent Living*
Male
Multimorbidity / trends*
Retrospective Studies
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding