Multimorbidity in heart failure: a community perspective

Abstract

Background: Comorbidities are a major concern in heart failure, leading to adverse outcomes, increased health care utilization, and excess mortality. Nevertheless, the epidemiology of comorbid conditions and differences in their occurrence by type of heart failure and sex are not well documented.

Methods: The prevalence of 16 chronic conditions defined by the US Department of Health and Human Services was obtained among 1382 patients from Olmsted County, Minn. diagnosed with first-ever heart failure between 2000 and 2010. Heat maps displayed the pairwise prevalences of the comorbidities and the observed-to-expected ratios for occurrence of morbidity pairs by type of heart failure (preserved or reduced ejection fraction) and sex.

Results: Most heart failure patients had 2 or more additional chronic conditions (86%); the most prevalent were hypertension, hyperlipidemia, and arrhythmias. The co-occurrence of other cardiovascular diseases was common, with higher prevalences of co-occurring cardiovascular diseases in men compared with women. Patients with preserved ejection fraction had one additional condition compared with those with reduced ejection fraction (mean 4.5 vs 3.7). The patterns of co-occurring conditions were similar between preserved and reduced ejection fraction; however, differences in the ratios of observed-to-expected co-occurrence were apparent by type of heart failure and sex. In addition, some psychological and neurological conditions co-occurred more frequently than expected.

Conclusion: Multimorbidity is common in heart failure, and differences in co-occurrence of conditions exist by type of heart failure and sex, highlighting the need for a better understanding of the clinical consequences of multiple chronic conditions in heart failure patients.

Keywords: Comorbidity; Heart failure; Multimorbidity.

Figure 1

Prevalence of individual chronic conditions in heart failure patients with preserved and reduced ejection fraction Left panel, men; Right panel, women

Figure 2

Proportion of co-occurring chronic conditions in heart failure patients in four strata: men with preserved and with reduced ejection fraction, and women with preserved and with reduced ejection fraction Left panel, men; Right panel, women The upper right of the figure corresponds to heart failure with preserved ejection fraction and the lower left corresponds to heart failure with reduced ejection fraction. Percentages indicate the individual prevalence of each chronic condition. The colors of each square indicate the percent of patients with both chronic conditions. Pulmonary disease indicates chronic obstructive pulmonary disease

Figure 3

Ratio of observed to expected co-occurrence of chronic conditions in heart failure patients in four strata: men with preserved and with reduced ejection fraction, and women with preserved and with reduced ejection fraction Left panel, men; Right panel, women The upper right of the figure corresponds to heart failure with preserved ejection fraction and the lower left corresponds to heart failure with reduced ejection fraction. The colors of each square correspond to the ratio of the observed to expected co-occurrence of chronic condition pairs. Asterisks represent significant p-values adjusted for multiple comparisons by controlling for the false discovery rate. Pulmonary disease indicates chronic obstructive pulmonary disease; O/E ratio indicates ratio of observed to expected co-occurrence