Resumen de Multimorbidity burden and adverse outcomes in a community‐based cohort of adults with heart failure

Mayra Tisminetzky, Jerry H. Gurwitz, Dongjie Fan, Kristi Reynolds, David H. Smith, David J. Magid, Sue Hee Sung, Terrence E. Murphy, Robert J. Goldberg, Alan S. Go

• OBJECTIVES To assess multimorbidity burden and its association with clinical outcomes in adults with heart failure (HF) according to sex, age, and HF type.

  DESIGN Retrospective cohort study.

  SETTING Five healthcare delivery systems across the United States.

  PARTICIPANTS Adults with HF (N=114,553).

  MEASUREMENTS We characterized participants with respect to the presence of 26 chronic conditions categorized into quartiles based on overall burden of comorbidity (<5, 5–6, 7–8, ≥9). Outcomes included all‐cause death and hospitalization for HF or any cause. Multivariable Cox regression was used to evaluate the adjusted association between categorized burden of multimorbidity burden and outcomes.

  RESULTS Individuals with more morbidities were more likely to die than those with fewer then 5 morbidities (5–6 morbidities: adjusted hazard ratio (aHR)=1.27 (95% confidence interval (CI)=1.24–1.31; 7–8 morbidities: aHR=1.52, 95% CI=1.48–1.57; ≥9 morbidities: aHR=1.92, 95% CI=1.86–1.99). There was a graded, higher adjusted rate of any‐cause hospitalization associated with 5 or 6 (aHR=1.28, 95% CI=1.25–1.30), 7 or 8 (aHR=1.47, 95% CI=1.44–1.50), or 9 or more (aHR=1.77, 95% CI=1.73–1.82) morbidities (vs <5). Similar findings were observed for HF‐specific hospitalization in those with 5 or 6 (aHR=1.22, 95% CI=1.19–1.26), 7 or 8 (aHR=1.39, 95% CI=1.34–1.44), or 9 or more (aHR 1.68, 95% CI=1.61–1.74) morbidities (vs <5). Consistent findings were seen according to sex, age group, and HF type (preserved, reduced, borderline HF), in the association between categorical burden of multimorbidity and outcomes especially prominent in individuals younger than 65.

  CONCLUSION After adjustment, higher levels of multimorbidity predicted worse HF outcomes and may be an important consideration in strategies to improve clinical and person‐centered outcomes. J Am Geriatr Soc 66:2305–2313, 2018.