Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis

Rashid, Muhammad; Kwok, Chun Shing; Gale, Chris P; Doherty, Patrick; Olier, Iván; Sperrin, Matthew; Kontopantelis, Evangelos; Peat, George; Mamas, Mamas A.

doi:10.1093/ehjqcco/qcw025

Cited by 71 publications

(68 citation statements)

References 61 publications

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“…However, care must be taken in interpreting this result because it is possible that other unmeasured comorbidities were present in the older adults that may have biased the estimates. 36,37 Our findings have important implications regarding care and outcomes in women, particularly as patients with AMI are living much longer. 38 We clearly showed that the gap in mortality between the sexes decreased for STEMI and almost disappeared for NSTEMI after adjusting for treatments at discharge.…”

Section: Discussionmentioning

confidence: 87%

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Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry

Alabas

Gale

Hall

et al. 2017

JAHA

148

122

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BackgroundThis study assessed sex differences in treatments, all‐cause mortality, relative survival, and excess mortality following acute myocardial infarction.Methods and ResultsA population‐based cohort of all hospitals providing acute myocardial infarction care in Sweden (SWEDEHEART [Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies]) from 2003 to 2013 was included in the analysis. Excess mortality rate ratios (EMRRs), adjusted for clinical characteristics and guideline‐indicated treatments after matching by age, sex, and year to background mortality data, were estimated. Although there were no sex differences in all‐cause mortality adjusted for age, year of hospitalization, and comorbidities for ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI at 1 year (mortality rate ratio: 1.01 [95% confidence interval (CI), 0.96–1.05] and 0.97 [95% CI, 0.95–0.99], respectively) and 5 years (mortality rate ratio: 1.03 [95% CI, 0.99–1.07] and 0.97 [95% CI, 0.95–0.99], respectively), excess mortality was higher among women compared with men for STEMI and non‐STEMI at 1 year (EMRR: 1.89 [95% CI, 1.66–2.16] and 1.20 [95% CI, 1.16–1.24], respectively) and 5 years (EMRR: 1.60 [95% CI, 1.48–1.72] and 1.26 [95% CI, 1.21–1.32], respectively). After further adjustment for the use of guideline‐indicated treatments, excess mortality among women with non‐STEMI was not significant at 1 year (EMRR: 1.01 [95% CI, 0.97–1.04]) and slightly higher at 5 years (EMRR: 1.07 [95% CI, 1.02–1.12]). For STEMI, adjustment for treatments attenuated the excess mortality for women at 1 year (EMRR: 1.43 [95% CI, 1.26–1.62]) and 5 years (EMRR: 1.31 [95% CI, 1.19–1.43]).ConclusionsWomen with acute myocardial infarction did not have statistically different all‐cause mortality, but had higher excess mortality compared with men that was attenuated after adjustment for the use of guideline‐indicated treatments. This suggests that improved adherence to guideline recommendations for the treatment of acute myocardial infarction may reduce premature cardiovascular death among women.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT02952417.

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Section: Discussionmentioning

confidence: 87%

“…Age was significantly associated with excess mortality even after adjusting for sex, comorbidities, and treatments. However, care must be taken in interpreting this result because it is possible that other unmeasured comorbidities were present in the older adults that may have biased the estimates 36, 37…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry

Alabas

Gale

Hall

et al. 2017

JAHA

148

122

View full text Add to dashboard Cite

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“…These reflect variables which are not captured but which are related to both (nonblinded) treatment allocation and to outcome. Among these are factors such as frailty and noncardiovascular comorbidity . However, in this particular work, clinical assessment of frailty or multimorbidity would be expected to lead to use of Ticagrelor or Prasugrel in “less frail”/multimorbid patients overall; and hence any confounding in this regard should favor outcomes in the potent P2Y12 groups.…”

Section: Discussionmentioning

confidence: 99%

Antiplatelet drug selection in PCI to vein grafts in patients with acute coronary syndrome and adverse clinical outcomes: Insights from the British Cardiovascular Intervention Society database

Sirker

Kwok

Kontopantelis

et al. 2018

Cathet Cardio Intervent

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“…Comorbidities rarely occur in isolation, with patients having multiple comorbid conditions that may impact on a patient's clinical course synergistically, rather than in isolation. Data on the influence of global measures of comorbid burden and their impact on clinical outcomes are relatively limited, and mainly derived from small cohorts limited to single centres . In the Nobori‐2 study, the risk of cardiac mortality post PCI in patients with a high global comorbid burden as defined by the Charlson comorbidity score was quadruple compared to cohorts with no comorbid conditions …”

Section: Introductionmentioning

confidence: 99%

“…Data on the influence of global measures of comorbid burden and their impact on clinical outcomes are relatively limited, and mainly derived from small cohorts limited to single centres. 2,4 In the Nobori-2 study, the risk of cardiac mortality post PCI in patients with a high global comorbid burden as defined by the Charlson comorbidity score was quadruple compared to cohorts with no comorbid conditions. 2 The Elixhauser classification system 10 (ECS) is one of the most commonly used measures of comorbid burden and comprises 30 comorbidity measures used to derive a weighted comorbidity score (van Walraven Elixhauser comorbidity score) to assess global comorbid burden.…”

Section: Introductionmentioning

confidence: 99%

The influence of Elixhauser comorbidity index on percutaneous coronary intervention outcomes

Potts

Nagaraja

Suwaidi

et al. 2019

Cathet Cardio Intervent

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Background Clinical outcomes with respect to the evolution of comorbidity burden in national cohorts of patients undergoing PCI have not been reported. Objectives We sought to explore the association between comorbidity burden and periprocedural outcomes in patients treated with PCI in the National Inpatient Sample. Methods 6,601,526 PCI procedures were identified between 2004 and 2014 and comorbidities were defined by the Elixhauser classification system (ECS) consisting of 30 comorbidity measures. Endpoints included in‐hospital mortality, periprocedural complications, length of stay and cost. Patients were classified based on their ECS in five categories (ECS I < 0, ECS II = 0, ECS III = 1–5, ECS IV = 6–13, and ECS V ≥ 14). Results Patients with a score over 13 had a fivefold increase in the odds of mortality (OR: 5.13, 95% CI: 4.76–5.54), major bleeding (OR: 11.46, 95% CI: 10.66–12.33) and doubled the hospitalization costs ($31,452 vs $17.566). Conclusions Our study of over six million PCI procedures demonstrates that patients with the greatest comorbid burden (as defined by an ECS of >13) have a fivefold increase risk of in‐hospital mortality, a fourfold increase in in‐hospital periprocedural complications and an 11‐fold increase in major bleeding events once differences in baseline patient characteristics are adjusted for. In addition, ECS significantly impacts the length of stay and doubles the healthcare costs. Comorbid burden is an important predictor of poor outcomes after PCI and should be considered as part of the decision‐making processes in patients undergoing PCI.

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Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis

Cited by 71 publications

References 61 publications

Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry

Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry

Antiplatelet drug selection in PCI to vein grafts in patients with acute coronary syndrome and adverse clinical outcomes: Insights from the British Cardiovascular Intervention Society database

The influence of Elixhauser comorbidity index on percutaneous coronary intervention outcomes

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