TY - JOUR
T1 - Multimorbidity in Heart Failure
T2 - Effect on Outcomes
AU - Manemann, Sheila M.
AU - Chamberlain, Alanna M.
AU - Boyd, Cynthia M.
AU - Gerber, Yariv
AU - Dunlay, Shannon M.
AU - Weston, Susan A.
AU - Jiang, Ruoxiang
AU - Roger, Véronique L.
N1 - Funding Information:
We thank Ellen E. Koepsell, RN, and Deborah S. Strain for their study support. Conflict of Interest: Sheila Manemann has received funding from the NIA and NHLBI for work on this project (PI: Roger). Alanna Chamberlain has received funding from the NHLBI for work on this project (PI: Roger). Cynthia Boyd is a coauthor of a chapter on multimorbidity for uptodate. She has received funding from the NHLBI for work on this project (PI: Roger). Shannon Dunlay's only funding is from NIH/NHLBI and she is the site PI for a Patient-Centered Outcomes Research Institute–funded trial. Susan Weston has received funding from the NIA and NHLBI for the work on this project (PI: Roger). Véronique Roger has received funding from the NIA and NHLBI for the work on this project (PI: Roger). This work was supported by Grants R21 AG045228 and R01 AG034676 from the National Institute on Aging (NIA) and Grant R01 HL120859 from the National Heart, Lung and Blood Institute (NHLBI). 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. Author Contributions: Dr. Roger had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Manemann, Roger: study concept and design. Manemann, Chamberlain, Weston, Roger: drafting of manuscript. All authors: critical revision of manuscript for important intellectual content. Manemann, Weston, Jiang: statistical analysis. Roger: obtained funding, study supervision Sponsor's Role: The sponsor was not involved in the design, methods, subject recruitment, data collections, analysis or preparation of the paper.
Publisher Copyright:
© 2016, The American Geriatrics Society
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Objectives: To investigate the effect of the number and type of comorbid conditions on death and hospitalizations in individuals with incident heart failure (HF). Design: Population-based cohort study. Setting: Olmsted County, Minnesota. Participants: Olmsted County, Minnesota, residents with incident HF from 2000 to 2010 (mean age 76 ± 14, 56% female) (N = 1,714). Measurements: The prevalence of 16 chronic conditions obtained at HF diagnosis classified into three groups: cardiovascular (CV) related, other physical, and mental. Results: The mean number of conditions per participant was 2.6 ± 1.5 for CV-related conditions, 1.3 ± 1.1 for other physical conditions, and 0.30 ± 0.61 for mental conditions. After a mean follow-up of 4.2 years, 1,073 deaths and 6,306 hospitalizations had occurred. After adjustment for age, sex, ejection fraction, in- or outpatient status, and number of other conditions, an increase of one other physical condition was associated with a 14% (HR = 1.14, 95% CI = 1.08–1.20) greater risk of death and a 26% (HR = 1.26, 95% CI = 1.20–1.32) greater risk of hospitalization, and an increase of one mental condition was associated with a 31% (HR = 1.31, 95% CI = 1.19–1.44) greater risk of death and an 18% (HR = 1.18, 95% CI = 1.07–1.29) greater risk of hospitalization. In contrast, an increase of one CV-related condition was not associated with greater risk of death and was associated with a 10% (HR = 1.10, 95% CI = 1.06–1.15) greater risk of hospitalization. Conclusion: CV-related conditions are the most common type of comorbid conditions in individuals with HF, but other physical and mental conditions are more strongly associated with death and hospitalizations. This underscores the effect of non-CV conditions on outcomes in HF.
AB - Objectives: To investigate the effect of the number and type of comorbid conditions on death and hospitalizations in individuals with incident heart failure (HF). Design: Population-based cohort study. Setting: Olmsted County, Minnesota. Participants: Olmsted County, Minnesota, residents with incident HF from 2000 to 2010 (mean age 76 ± 14, 56% female) (N = 1,714). Measurements: The prevalence of 16 chronic conditions obtained at HF diagnosis classified into three groups: cardiovascular (CV) related, other physical, and mental. Results: The mean number of conditions per participant was 2.6 ± 1.5 for CV-related conditions, 1.3 ± 1.1 for other physical conditions, and 0.30 ± 0.61 for mental conditions. After a mean follow-up of 4.2 years, 1,073 deaths and 6,306 hospitalizations had occurred. After adjustment for age, sex, ejection fraction, in- or outpatient status, and number of other conditions, an increase of one other physical condition was associated with a 14% (HR = 1.14, 95% CI = 1.08–1.20) greater risk of death and a 26% (HR = 1.26, 95% CI = 1.20–1.32) greater risk of hospitalization, and an increase of one mental condition was associated with a 31% (HR = 1.31, 95% CI = 1.19–1.44) greater risk of death and an 18% (HR = 1.18, 95% CI = 1.07–1.29) greater risk of hospitalization. In contrast, an increase of one CV-related condition was not associated with greater risk of death and was associated with a 10% (HR = 1.10, 95% CI = 1.06–1.15) greater risk of hospitalization. Conclusion: CV-related conditions are the most common type of comorbid conditions in individuals with HF, but other physical and mental conditions are more strongly associated with death and hospitalizations. This underscores the effect of non-CV conditions on outcomes in HF.
KW - epidemiology
KW - heart failure
KW - multimorbidity
KW - outcomes
KW - population
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U2 - 10.1111/jgs.14206
DO - 10.1111/jgs.14206
M3 - Article
C2 - 27348135
AN - SCOPUS:84978420905
SN - 0002-8614
VL - 64
SP - 1469
EP - 1474
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 7
ER -