Association of multimorbidity and changes in health-related quality of life following myocardial infarction: a UK multicentre longitudinal patient-reported outcomes study

Abstract

Background Multimorbidity is prevalent for people with myocardial infarction (MI), yet previous studies investigated single-health conditions in isolation. We identified patterns of multimorbidity in MI survivors and their associations with changes in HRQoL. Methods In this national longitudinal cohort study, we analysed data from 9566 admissions with MI from 77 National Health Service hospitals in England between 2011 and 2015. HRQoL was measured using EuroQol 5 dimension (EQ5D) instrument and visual analogue scale (EQVAS) at hospitalisation, 6, and 12 months following MI. Latent class analysis (LCA) of pre-existing long-term health conditions at baseline was used to identify clusters of multimorbidity and associations with changes in HRQoL quantified using mixed effects regression analysis. Results Of 9566 admissions with MI (mean age of 64.1 years [SD 11.9], 7154 [75%] men), over half (5119 [53.5%] had multimorbidities. LCA identified 3 multimorbidity clusters which were severe multimorbidity (591; 6.5%) with low HRQoL at baseline (EQVAS 59.39 and EQ5D 0.62) which did not improve significantly at 6 months (EQVAS 59.92, EQ5D 0.60); moderate multimorbidity (4301; 47.6%) with medium HRQoL at baseline (EQVAS 63.08, EQ5D 0.71) and who improved at 6 months (EQVAS 71.38, EQ5D 0.76); and mild multimorbidity (4147, 45.9%) at baseline (EQVAS 64.57, EQ5D 0.75) and improved at 6 months (EQVAS 76.39, EQ5D 0.82). Patients in the severe and moderate groups were more likely to be older, women, and presented with NSTEMI. Compared with the mild group, increased multimorbidity was associated with lower EQ-VAS scores (adjusted coefficient: −5.12 [95% CI −7.04 to −3.19] and −0.98 [−1.93 to −0.04] for severe and moderate multimorbidity, respectively. The severe class was more likely than the mild class to report problems in mobility, OR 9.62 (95% confidence interval: 6.44 to 14.36), self-care 7.87 (4.78 to 12.97), activities 2.41 (1.79 to 3.26), pain 2.04 (1.50 to 2.77), and anxiety/depression 1.97 (1.42 to 2.74). Conclusions Among MI survivors, multimorbidity clustered into three distinct patterns and was inversely associated with HRQoL. The identified multimorbidity patterns and HRQoL domains that are mostly affected may help to identify patients at risk of poor HRQoL for which clinical interventions could be beneficial to improve the HRQoL of MI survivors. Trial registration ClinicalTrials.gov NCT01808027 and NCT01819103

Work Content of General Practitioners in Beijing, China: A Multi-method Study

“…In this study, physical examination was observed in only 15.5% GP-patient consultations, while it was observed in 64.5% of GP-patient consultations in Australia ( 31 ), 79% in Estonia ( 32 ), and 72.8% in Guangzhou, China ( 17 ). Similarly, test (laboratory or imaging test) in GP-patient consultations were infrequent (17.1% consultations) in the present study, while it was recorded at 29.0% of encounters in Australia ( 29 ). This situation may be mainly due to the fact that most (84.6%) encounters in general practice clinics in the present study were revisiting to the general practice clinics.…”

“…Multimorbidity has been rising in prevalence over recent years. In China, 30.3% of older adults reported multimorbidity ( 28 ), while the prevalence of multimorbidity was 53.5% in UK ( 29 ), 19.5% in 45.6% in Canada ( 30 ). In China, people with multimorbidity need to visit multiple specialists if they want to receive care in hospital.…”

Impact of multimorbidity on long-term outcomes in older adults with non-ST elevation acute coronary syndrome in the North East of England: a multi-centre cohort study of patients undergoing invasive care

“… 27 In a large national longitudinal cohort study, increasing comorbidity was associated with worsening HRQoL. 28 The large increase in the risk of death at 5 years that we show suggests that the primary focus in older adults with significant multimorbidity and NSTE-ACS should be on interventions that also provide benefits in quality of life. Given the paucity of existing evidence, there is need for randomised trials in older people with comorbidities to guide the most appropriate management strategies and allow honest, patient-centred discussions about the goals of management.…”

“…The importance of the impact of cardiac interventions on health-related quality of life (HRQoL) is being increasingly recognised in this older population—but is often reported to be poor by older adults following NSTE-ACS 27. In a large national longitudinal cohort study, increasing comorbidity was associated with worsening HRQoL 28. The large increase in the risk of death at 5 years that we show suggests that the primary focus in older adults with significant multimorbidity and NSTE-ACS should be on interventions that also provide benefits in quality of life.…”

Prognostic Impact of Non-cardiac Comorbidities on Long-Term Prognosis in Patients with Reduced and Preserved Ejection Fraction Following Acute Myocardial Infarction

“…Due to improved survival, patients with stable chronic coronary disease post STEMI represent an increasingly important and prevalent population [2,3,4]. Non-cardiac comorbidities are frequent in patients with acute myocardial infarction (AMI) [4,5]. The presence of non-cardiac comorbidities in patients with AMI can be explained by the presence of the same risk factors for both AMI and non-cardiac comorbidity (e.g., smoking is also a risk factor for chronic obstructive pulmonary disease, peripheral artery disease, stroke, etc.…”