TY - JOUR
T1 - Multimorbidity and Functional Limitation in Individuals with Heart Failure
T2 - A Prospective Community Study
AU - Manemann, Sheila M.
AU - Chamberlain, Alanna M.
AU - Roger, Véronique L.
AU - Boyd, Cynthia
AU - Cheville, Andrea
AU - Dunlay, Shannon M.
AU - Weston, Susan A.
AU - Jiang, Ruoxiang
AU - Rutten, Lila J.Finney
N1 - Funding Information:
We thank Ellen Koepsell, RN, Dawn Schubert, RN, Sandra Severson, RN, and Deborah Strain for their study support. Financial Disclosure: This work was supported by grants from the National Heart, Lung and Blood Institute (R01 HL120859) and the Patient Centered Outcomes Research Institute (CDRN-1501–26638) and was made possible by the Rochester Epidemiology Project, Rochester, Minnesota (R01 AG034676) of the National Institute on Aging. The funding sources played no role in the design, conduct, or reporting of this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Conflict of Interest: None. Author Contributions: Manemann, Rutten, Roger, Chamberlain: study concept and design. Manemann, Weston, Jiang: acquisition of subjects and data, analysis and interpretation of data. Manemann, Rutten: preparation of manuscript. All authors: critical revision and final approval of manuscript. Sponsor's Role: The funding sources played no role in the design, conduct, or reporting of this study.
Funding Information:
Financial Disclosure: This work was supported by grants from the National Heart, Lung and Blood Institute (R01 HL120859) and the Patient Centered Outcomes Research Institute (CDRN-1501–26638) and was made possible by the Rochester Epidemiology Project, Rochester, Minnesota (R01 AG034676) of the National Institute on Aging. The funding sources played no role in the design, conduct, or reporting of this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Conflict of Interest: None.
Publisher Copyright:
© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society
PY - 2018/6
Y1 - 2018/6
N2 - Objectives: To characterize the individual and combined effects of multimorbidity and functional limitation on healthcare use and mortality in a large, community cohort of individuals with heart failure (HF). Design: Prospective cohort study. Setting: Eleven southeastern Minnesota counties. Participants: Individuals (mean age 74, 54% male) with a first-ever HF code (International Classification of Diseases, Ninth Revision code 428 or Tenth Revision code I50) between January 1, 2013 and March 31, 2016 (N=2,692). Measurements: Eight activities of daily living measured using a survey on a Likert scale (1=without any difficulty, 5=unable to do; median=8). Participants with a score greater than 8 were categorized as having functional limitation. Multimorbidity was defined as having 2 or more noncardiac comorbidities. Results: Twenty-five percent of participants had neither multimorbidity nor functional limitation, 35% had multimorbidity, 9% had functional limitation, and 31% had both. After adjustment, participants with multimorbidity and functional limitation had greater risks of all outcomes (death: hazard ratio (HR)=4.92, 95% confidence interval (CI)=3.03–8.00; emergency department (ED) visit: HR=3.67, 95% CI=2.94–4.59; hospitalization: HR=3.66, 95% CI=2.85–4.70; outpatient visit: HR=1.73, 95% CI=1.52–1.96) than those with neither. Participants with functional limitation alone had greater risks of death (HR=4.84, 95% CI=2.78–8.43), ED visits (HR=2.35, 95% CI=1.75–3.16), and hospitalizations (HR=2.10, 95% CI=1.52–2.88) but not outpatient visits. Those with multimorbidity alone had similar risks of ED visits and hospitalizations as those with functional limitation alone but were more likely to have outpatient visits (HR=1.50, 95% CI=1.34–1.67). Conclusion: Individuals with both multimorbidity and functional limitation have the highest risk of death and healthcare use. Individuals with only functional limitation have similar rates of hospitalizations and ED visits as those with only multimorbidity, underscoring the need to consider both when managing individuals with HF.
AB - Objectives: To characterize the individual and combined effects of multimorbidity and functional limitation on healthcare use and mortality in a large, community cohort of individuals with heart failure (HF). Design: Prospective cohort study. Setting: Eleven southeastern Minnesota counties. Participants: Individuals (mean age 74, 54% male) with a first-ever HF code (International Classification of Diseases, Ninth Revision code 428 or Tenth Revision code I50) between January 1, 2013 and March 31, 2016 (N=2,692). Measurements: Eight activities of daily living measured using a survey on a Likert scale (1=without any difficulty, 5=unable to do; median=8). Participants with a score greater than 8 were categorized as having functional limitation. Multimorbidity was defined as having 2 or more noncardiac comorbidities. Results: Twenty-five percent of participants had neither multimorbidity nor functional limitation, 35% had multimorbidity, 9% had functional limitation, and 31% had both. After adjustment, participants with multimorbidity and functional limitation had greater risks of all outcomes (death: hazard ratio (HR)=4.92, 95% confidence interval (CI)=3.03–8.00; emergency department (ED) visit: HR=3.67, 95% CI=2.94–4.59; hospitalization: HR=3.66, 95% CI=2.85–4.70; outpatient visit: HR=1.73, 95% CI=1.52–1.96) than those with neither. Participants with functional limitation alone had greater risks of death (HR=4.84, 95% CI=2.78–8.43), ED visits (HR=2.35, 95% CI=1.75–3.16), and hospitalizations (HR=2.10, 95% CI=1.52–2.88) but not outpatient visits. Those with multimorbidity alone had similar risks of ED visits and hospitalizations as those with functional limitation alone but were more likely to have outpatient visits (HR=1.50, 95% CI=1.34–1.67). Conclusion: Individuals with both multimorbidity and functional limitation have the highest risk of death and healthcare use. Individuals with only functional limitation have similar rates of hospitalizations and ED visits as those with only multimorbidity, underscoring the need to consider both when managing individuals with HF.
KW - functional limitation
KW - heart failure
KW - multimorbidity
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=85044773032&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044773032&partnerID=8YFLogxK
U2 - 10.1111/jgs.15336
DO - 10.1111/jgs.15336
M3 - Article
C2 - 29603724
AN - SCOPUS:85044773032
SN - 0002-8614
VL - 66
SP - 1101
EP - 1107
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 6
ER -