Impact of non-cardiovascular disease comorbidity on cardiovascular disease symptom severity: a population-based study

Abstract

Objectives: Non-cardiovascular comorbidity is common in cardiovascular disease (CVD) populations but its influence on chest pain (CP) and shortness of breath (SOB) symptom-specific physical limitations is unknown. We wanted to test the a priori hypothesis that an unrelated comorbidity would influence symptom-specific physical limitations and to investigate this impact in different severities of CVD.

Method and results: The study was based on 5426 patients from ten family practices, organised into eight a priori exclusive severity groups: (i) no CVD or osteoarthritis (OA) (reference), (ii) index hypertension, ischaemic heart disease (IHD) and heart failure (HF) without OA, (iii) index OA without CVD and (iv) same CVD groups with comorbid OA. The measure of CP physical limitations was Seattle Angina Questionnaire and for SOB physical limitations was the Kansas City Cardiomyopathy Questionnaire. Adjusted baseline associations between the cohorts and symptom-specific physical limitations were assessed using linear regression methods. In the study population, 1443 (27%) reported CP and 2097 (39%) SOB. CP and SOB physical limitations increased with CVD severity in the index and comorbid groups. Compared with the respective index CVD group, the CP physical limitation scores for comorbid CVD groups with OA were lower by: -14.7 (95% CI -21.5, 7.8) for hypertension, -5.5 (-10.4, -0.7) for IHD and -22.1 (-31.0, -6.7) for HF. For SOB physical limitations, comorbid scores were lower by: -9.2 (-13.8, -4.6) for hypertension, -6.4 (-11.1, -1.8) for IHD and -8.8 (-19.3, 1.65) for HF.

Conclusions: CP and SOB are common symptoms, and OA increases the CVD symptom-specific physical limitations additively. Comorbidity interventions need to be developed for CVD specific health outcomes.

Keywords: Cardiovascular diseases; Comorbidity; Health status; Osteoarthritis.

Fig. 1

Chest pain physical limitation score difference of the study groups compared to reference group. Reference group without CVD or osteoarthritis (OA), index CVD groups without OA (hypertension (BP), ischaemic heart disease (IHD) and chronic heart failure (HF)), index OA group without CVD categories and comorbid (CVD and OA) groups; chest pain physical limitation from Seattle Angina Questionnaire.

Fig. 2

Shortness of breath physical limitation score difference of the study groups compared to reference group. Reference group without CVD or osteoarthritis (OA), index CVD groups without OA (hypertension (BP), ischaemic heart disease (IHD) and chronic heart failure (HF)), index OA group without CVD categories and comorbid (CVD and OA) groups; shortness of breath physical limitation from Kansas City Cardiomyopathy Questionnaire.

Fig. 3

Observed and expected estimates for chest pain physical limitations. Index groups; hypertension (BP), ischaemic heart disease (IHD), heart failure (HF), osteoarthritis (OA) expected chest pain physical limitation scores were derived from the sum of the independent effects of the CVD and OA index groups, which were compared to the observed scores (o) in the comorbid groups (chest pain physical limitation from Seattle Angina Questionnaire).

Fig. 4

Observed and expected estimates for shortness of breath physical limitation. Index groups; hypertension (BP), ischaemic heart disease (IHD), heart failure (HF), osteoarthritis (OA) expected shortness of breath physical limitation scores (e) were derived from the sum of the independent effects of the CVD and OA index groups, which were compared to the observed scores (o) in the comorbid groups (shortness of breath physical limitation from Kansas City Cardiomyopathy Questionnaire).