Comorbidity in patients with cardiovascular disease in primary care: a cohort study with routine healthcare data

Abstract

Background: Comorbidity is a major public health issue, which challenges health care configured around single diseases.

Aim: To provide an overview of frequent disease combinations of one and two additional chronic diseases and groups among patients with cardiovascular disease (CVD) in general practice.

Design and setting: Medical record data from the Julius General Practitioners' Network of 226 670 patients registered in 2015-2016 in Utrecht, the Netherlands, were collected and examined.

Method: Prevalences and combinations of one and two comorbid conditions were determined, by age and sex, in four populations of patients with CVD: heart failure, peripheral arterial disease (PAD), coronary heart disease (CHD), or stroke. Using logistic regression analyses, the authors examined whether comorbid conditions were significantly more prevalent in patients with a specific cardiovascular condition compared with those without.

Results: Low vision, diabetes mellitus, back/neck problems, osteoarthritis, chronic obstructive pulmonary disease (COPD), and cancer were the most prevalent non-cardiovascular conditions and ranked in the top five of non-cardiovascular comorbid conditions in the different CVDs studied, irrespective of patient age and sex. Of these, diabetes, COPD, and low vision were statistically significantly more prevalent in all four cardiovascular conditions when compared with patients without the respective disease. Over the life span, the majority of the comorbid conditions were most prevalent in patients with heart failure, directly followed by those with PAD; they were less prevalent in patients with CHD and stroke.

Conclusion: Comorbid conditions are very common in patients with CVD, even in younger age groups. To ensure efficient and effective treatment, organisational adaptations may be required in the healthcare system to accommodate comorbid conditions in patients with CVD.

Keywords: cardiovascular diseases; chronic disease; epidemiology; general practice; primary health care.

Figure 1.

Cluster diagram of the most common comorbid conditions in patients with a) heart failure, b) peripheral arterial disease, c) coronary heart disease, and d) stroke. Each circle gives the crude prevalence, followed by the odds ratio and 95% CI, adjusted for age and sex. Percentages next to lines that connect the cardiovascular comorbid disease group with other diseases or disease groups represent the prevalence of having both a cardiovascular comorbid condition as well as the non-cardiovascular condition. Percentages not connected to a line or circle indicate the prevalence of the muscular diseases grouped. As an example, 19% of the patients with heart failure have both an additional cardiovascular disease as well as diabetes mellitus. Only prevalences >2.5% are shown. Circle size is proportional to the prevalence. CHD = coronary heart disease. COPD = chronic obstructive pulmonary disease. De = dementia. HF = heart failure. PAD = peripheral arterial disease. RA = rheumatoid arthritis.