Multimorbidity patterns in patients with heart failure: an observational Spanish study based on electronic health records

Abstract

ObjectivesTo characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the impact of such patterns on the risk of hospitalisation and mortality.DesignObservational retrospective population study based on electronic health records.SettingEpiChron Cohort (Aragón, Spain).ParticipantsAll the primary and hospital care patients of the EpiChron Cohort with a diagnosis of HF on 1 January 2011 (ie, 8488 women and 6182 men). We analysed all the chronic diseases registered in patients’ electronic health records until 31 December 2011.Primary outcomeWe performed an exploratory factor analysis to identify the multimorbidity patterns in men and women, and logistic and Cox proportional-hazards regressions to investigate the association between the patterns and the risk of hospitalisation in 2012, and of 3-year mortality.ResultsAlmost all HF patients (98%) had multimorbidity, with an average of 7.8 chronic diseases per patient. We identified six different multimorbidity patterns, named cardiovascular, neurovascular, coronary, metabolic, degenerative and respiratory. The most prevalent were the degenerative (64.0%) and cardiovascular (29.9%) patterns in women, and the metabolic (49.3%) and cardiovascular (43.2%) patterns in men. Every pattern was associated with higher hospitalisation risks; and the cardiovascular, neurovascular and respiratory patterns significantly increased the likelihood of 3-year mortality.ConclusionsMultimorbidity is the norm rather than the exception in patients with heart failure, whose comorbidities tend to cluster together beyond simple chance in the form of multimorbidity patterns that have different impact on health outcomes. This knowledge could be useful to better understand common pathophysiological pathways underlying this condition and its comorbidities, and the factors influencing the prognosis of men and women with HF. Further large scale longitudinal studies are encouraged to confirm the existence of these patterns as well as their differential impact on health outcomes.

Sex Differences in Comorbidity, Therapy, and Health Services’ Use of Heart Failure in Spain: Evidence from Real-World Data

“…As expected, multimorbidity was the rule rather than the exception in our population, affecting up to 99% of patients of both sexes. The burden of diseases was considerably similar in men and women, who presented six or more chronic conditions in 80% of cases, and a median of nine conditions, similar to that found in other studies [6,24,25,32,33]. Carmona et al [24] analyzed 198,670 patients, and more than 60% had five or more non-cardiac comorbidities.…”

“…There are, however, controversies regarding the effect of sex on the prevalence of chronic renal failure and diabetes, with contradictory results in the literature [25,32,[36][37][38][39]. The significant differences shown in COPD prevalence could be associated with higher levels of tobacco use in men [6,11,25], since toxic habits were clearly more frequent in men (although probably under-registered), as previously reported in the literature [8,11,26]. On the other hand, women were more likely to suffer conditions such as depression, osteoporosis, osteoarticular pathology, varicose veins, hypothyroidism, and asthma.…”

“…Males consumed more drugs for cardiovascular events than women did, which could be justified by the greater frequency of ischemic heart disease in men [6,41]. The greater combined use of ACE inhibitors/ARB, beta-blockers, and antialdosteronics could be justified by a higher prevalence of reduced LVEF in men [41].…”

“…Sex differences in the epidemiology, comorbidity, pharmacological treatment, and management of HF have been highlighted [3][4][5][6][7][8][9]. Although HF incidence is initially higher in men, women survive longer after the onset of the disease and, as one's age advances, its prevalence becomes higher in women compared to men [8].…”

“…Heart failure presents, in most cases, as a chronic disease with a high burden of comorbidities, some of which seem to be sex-specific [6]. Whereas women are more likely to present comorbid hypertension, diabetes, hypothyroidism, obesity, and depression, men tend to have more peripheral vascular disease, ischemic heart disease and chronic obstructive pulmonary disease (COPD) [9,11,12].…”