Multimorbidity in Incident Heart Failure: Characterisation and Impact on 1-Year Outcomes

Abstract

Background/Objectives: Heart failure (HF) is usually accompanied by other comorbidities, which, altogether, have a major impact on patients and healthcare systems. Our aim was to analyse the demographic and clinical characteristics of incident HF patients and the effect of comorbidities on one-year health outcomes. Methods: This was an observational, retrospective, population-based study of incident HF patients between 2014 and 2018 in the EpiChron Cohort, Spain. The included population contained all primary and hospital care patients with a diagnosis of HF. All chronic diseases in their electronic health records were pooled into three comorbidity clusters (cardiovascular, mental, other physical). These comorbidity groups and the health outcomes were analysed until 31 December 2018. A descriptive analysis was performed. Cox regression models and survival curves were calculated to determine the hazard risk (HR) of all-cause mortality, all-cause and HF-related hospital admissions, hospital readmissions, and emergency room visits for each comorbidity group. Results: In total, 13,062 incident HF patients were identified (mean age = 82.0 years; 54.8% women; 93.7% multimorbid; mean of 4.52 ± 2.06 chronic diseases). After one-year follow-up, there were 3316 deaths (25.3%) and 4630 all-cause hospitalisations (35.4%). After adjusting by gender, age, and inpatient/outpatient status, the mental cluster was associated (HR; 95% confidence interval) with a higher HR of death (1.08; 1.01-1.16) and all-cause hospitalisation (1.09; 1.02-1.16). Conclusions: Cardiovascular comorbidities are the most common and studied ones in HF patients; however, they are not the most strongly associated with negative impacts on health outcomes in these patients. Our findings suggest the importance of a holistic and integral approach in the care of HF patients and the need to take into account the entire spectrum of comorbidities for improving HF management in clinical practice.

Keywords: co-existing conditions; comorbidity; heart failure; hospital admission; mortality; multimorbidity.

Figure 1

Hazard ratios of mortality and all-cause hospital admission depending on the comorbidities present in patients with heart failure at the moment of diagnosis. COPD: chronic obstructive pulmonary disease. Hazard ratios are adjusted for age and in- or outpatient status at the time of diagnosis and accompanied by their respective 95% confidence intervals.

Figure 2

Hazard ratios of the five health outcomes analysed depending on the comorbidities present in patients with heart failure at the moment of diagnosis, stratified by gender. COPD: chronic obstructive pulmonary disease. Hazard ratios are adjusted for age and in- or outpatient status at the time of diagnosis and accompanied by their respective 95% confidence intervals.