Comorbidity phenotypes and risk of mortality in patients with ischaemic heart disease in the UK

Abstract

ObjectivesThe objective of this study is to use latent class analysis of up to 20 comorbidities in patients with a diagnosis of ischaemic heart disease (IHD) to identify clusters of comorbidities and to examine the associations between these clusters and mortality.MethodsLongitudinal analysis of electronic health records in the health improvement network (THIN), a UK primary care database including 92 186 men and women aged ≥18 years with IHD and a median of 2 (IQR 1–3) comorbidities.ResultsLatent class analysis revealed five clusters with half categorised as a low-burden comorbidity group. After a median follow-up of 3.2 (IQR 1.4–5.8) years, 17 645 patients died. Compared with the low-burden comorbidity group, two groups of patients with a high-burden of comorbidities had the highest adjusted HR for mortality: those with vascular and musculoskeletal conditions, HR 2.38 (95% CI 2.28 to 2.49) and those with respiratory and musculoskeletal conditions, HR 2.62 (95% CI 2.45 to 2.79). Hazards of mortality in two other groups of patients characterised by cardiometabolic and mental health comorbidities were also higher than the low-burden comorbidity group; HR 1.46 (95% CI 1.39 to 1.52) and 1.55 (95% CI 1.46 to 1.64), respectively.ConclusionsThis analysis has identified five distinct comorbidity clusters in patients with IHD that were differentially associated with risk of mortality. These analyses should be replicated in other large datasets, and this may help shape the development of future interventions or health services that take into account the impact of these comorbidity clusters.

Pathophysiological and clinical significance of mineral homeostasis disorders in the development of cardiovascular disease

“…При этом доля смертей, связанных с атеросклерозом (от ишемической болезни сердца, ишемического инсульта и заболеваний периферических артерий), составила около 66% от общего числа сердечно-сосудистых смертей [2]. Растущая смертность от сердечно-сосудистых заболеваний в значительной степени обусловлена увеличением доли пациентов с сопутствующими патологиями (так называемый феномен коморбидности), то есть с сочетанием заболеваний нескольких органов или их систем [3][4][5][6]. Высокая распространенность коморбидности, в свою очередь, связана с увеличением как общей продолжительности жизни, так и непосредственно продолжительности жизни пациентов с болезнями системы кровообращения вследствие успехов современной кардиологии и сердечно-сосудистой хирургии [3][4][5][6].…”

Phenotypic Disease Network Analysis to Identify Comorbidity Patterns in Hospitalized Patients with Ischemic Heart Disease Using Large-Scale Administrative Data

“…IHD co-occurs with other medical conditions far more commonly than expected by chance. Previous studies have reported high comorbidity between IHD and other chronic physical and mental disorders, such as hypertension [ 4 , 5 , 6 , 7 ], diabetes [ 7 , 8 , 9 ], chronic obstructive pulmonary disease (COPD) [ 7 , 10 ], and depression [ 11 , 12 ]. In fact, a study of 92,186 IHD patients in the United Kingdom observed that 84% of patients with IHD had one or more comorbidities, of which 47.1% had hypertension and 15.7% had diabetes [ 7 ].…”

“…Previous studies have reported high comorbidity between IHD and other chronic physical and mental disorders, such as hypertension [ 4 , 5 , 6 , 7 ], diabetes [ 7 , 8 , 9 ], chronic obstructive pulmonary disease (COPD) [ 7 , 10 ], and depression [ 11 , 12 ]. In fact, a study of 92,186 IHD patients in the United Kingdom observed that 84% of patients with IHD had one or more comorbidities, of which 47.1% had hypertension and 15.7% had diabetes [ 7 ]. Another meta-analysis based on the Charlson Comorbidity Index (CCI) found that diabetes and a history of prior myocardial infarction were the two most common comorbidities in patients with IHD [ 9 ].…”

“…Despite the growing amount of evidence that IHD has high co-existing morbidity burden, previous studies investigating IHD comorbidity have been predominately focused on a few common diseases and interpreted them using prevalence statistics and correlation analysis [ 7 , 9 , 10 , 12 , 13 ], without a comprehensive investigation of associations between comorbidities in patients with IHD, and most of these studies were conducted in Western countries [ 15 , 16 , 17 , 18 ]. There is still a significant gap in knowledge regarding the comorbidity patterns of IHD, especially among Chinese individuals, who tend to exhibit different lifestyles and eating habits from those observed in Western countries.…”

The comorbid patient: does your heart sink?

“…What will the natural history of the patient in front of us be with or without our intervention, taking into account the comorbidities—difficult questions to answer? In this issue of Heart , Crowe provides us with a new perspective on comorbid phenotypes 1. No single article is going to give us the answer but this one provides food for thought.…”