Prevalence of Noncardiac Multimorbidity in Patients Admitted to Two Cardiac Intensive Care Units and Their Association with Mortality

Abstract

Background: Current cardiac intensive care unit (CICU) practice has seen an increase in patient complexity, including an increase in noncardiac organ failure, critical care therapies, and comorbidities. We sought to describe the changing epidemiology of noncardiac multimorbidity in the CICU population.

Methods: We analyzed consecutive unique patient admissions to 2 geographically distant tertiary care CICUs (n = 16,390). We assessed for the prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities (diabetes, chronic lung, liver, and kidney disease, cancer, and stroke/transient ischemic attack) and their associations with hospital and postdischarge 1-year mortality using multivariable logistic regression.

Results: The prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities was 37.7%, 31.4%, 19.9%, and 11.0%, respectively. Increasing noncardiac comorbidities were associated with a stepwise increase in mortality, length of stay, noncardiac indications for ICU admission, and increased utilization of critical care therapies. After multivariable adjustment, compared with those without noncardiac comorbidities, there was an increased hospital mortality for patients with 1 (odds ratio [OR] 1.30; 95% confidence interval [CI], 1.10-1.54, P = .002), 2 (OR 1.47; 95% CI, 1.22-1.77, P < .001), and ≥3 (OR 1.79; 95% CI, 1.44-2.22, P < .001) noncardiac comorbidities. Similar trends for each additional noncardiac comorbidity were seen for postdischarge 1-year mortality (P < .001, all).

Conclusions: In 2 large contemporary CICU populations, we found that noncardiac multimorbidity was highly prevalent and a strong predictor of short- and long-term adverse clinical outcomes. Further study is needed to define the best care pathways for CICU patients with acute cardiac illness complicated by noncardiac multimorbidity.

Keywords: Cardiac intensive care unit; Comorbidity; Multimorbidity.

Figure 1:

Crude (A) hospital mortality and (B) post-discharge 1-year mortality in the combined cohorts as a function of the number of non-cardiac comorbidities.

Figure 1:

Crude (A) hospital mortality and (B) post-discharge 1-year mortality in the combined cohorts as a function of the number of non-cardiac comorbidities.

Figure 2:

Forest plot demonstrating adjusted odds ratio and 95% confidence interval values for hospital mortality for patients with 1, 2 or ≥3 non-cardiac comorbidities compared to patients without non-cardiac comorbidities as referent.

Figure 3:

Proportion of hospital mortality for each comorbidity group in the combined cohort.

Figure 4:

Proportion of hospital mortality for each diagnosis groups of interest.

Figure 5:

Forest plot demonstrating adjusted odds ratio and 95% confidence interval values for one-year mortality for patients with 1, 2 or ≥3 non-cardiac comorbidities compared to patients without non-cardiac comorbidities as referent. *Only patients whose vital status at one year is known are included.