Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure

Braunstein, Joel B.; Anderson, Gerard F.; Gerstenblith, Gary; Weller, Wendy E.; Niefeld, Marlene; Herbert, Robert J.; Wu, Albert W.

doi:10.1016/s0735-1097(03)00947-1

Cited by 670 publications

(553 citation statements)

References 34 publications

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“…36 Others have determined that patients with mental health conditions or chronic pain are at risk for receiving suboptimal care for their hypertension, diabetes, heart failure, arthritis, and chronic obstructive pulmonary disease. 31,[36][37][38][39][40] Other studies, however, suggest that these patterns are not universal. For example, patients with serious mental health conditions sometimes receive more intensive monitoring of their other chronic conditions.…”

Section: The Relationship Between Multimorbidity and Quality Of Carementioning

confidence: 99%

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

et al. 2013

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Multimorbidity-the presence of multiple chronic conditions in a patient-has a profound impact on health, health care utilization, and associated costs. Definitions of multimorbidity in clinical care and research have evolved over time, initially focusing on a patient's number of comorbidities and the associated magnitude of required care processes, and later recognizing the potential influence of comorbidity characteristics on patient care and outcomes. In this article, we review the relationship between multimorbidity and quality of care, and discuss how this relationship may be mediated by the degree to which conditions interact with one another to generate clinical complexity (comorbidity interrelatedness). Drawing on established theoretical frameworks from cognitive engineering and biomedical informatics, we describe how interactions among conditions result in clinical complexity and may affect quality of care. We discuss how this comorbidity interrelatedness influences the value of existing quality guidelines and performance metrics, and describe opportunities to quantify this construct using data widely available through electronic health records. Incorporating comorbidity interrelatedness into conceptualizations of multimorbidity has the potential to enhance clinical and research efforts that aim to improve care for patients with multiple chronic conditions.

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Section: The Relationship Between Multimorbidity and Quality Of Carementioning

confidence: 99%

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

et al. 2013

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“…This is of particular relevance to older adults with heart failure, as comorbidity in this population increases symptomatology 2 , polypharmacy 3 , risk of hospital readmissions 4,5 , and mortality [6][7][8][9][10] . Moreover, the management of comorbidity, particularly those conditions that are not directly related to heart failure in either pathogenesis or management, can significantly complicate the overall care needed by these patients 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Population-based data on the prevalence of comorbid conditions among older adults with heart failure have indicated a large burden of comorbidity; for example, Braustein et al (2003) reported that approximately 72% of Medicare beneficiaries with heart failure have at least five comorbid conditions 9 . These studies have examined older persons as a single cohort 9,11,12 , which may obscure important age-dependent differences in disease prevalence.…”

Section: Introductionmentioning

confidence: 99%

“…These studies have examined older persons as a single cohort 9,11,12 , which may obscure important age-dependent differences in disease prevalence. There has been little empiric investigation of changes in comorbidity prevalence as older adults with heart failure survive into very old age.…”

Section: Introductionmentioning

confidence: 99%

“…Existing data support two potentially opposing hypotheses regarding the relationship between comorbidity and advancing age. On the one hand, evidence linking certain comorbidities in heart failure to increased mortality [6][7][8][9][10] suggests that persons who survive to very old age with heart failure are less likely to have those comorbidities. On the other hand, the increase in prevalence with advancing age of several chronic diseases unrelated to heart failure, such as dementia [13][14][15][16] , suggests that older adults with heart failure may accumulate comorbidity as they survive into old age.…”

Section: Introductionmentioning

confidence: 99%

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Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure

et al. 2011

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BACKGROUND: Comorbidity-a condition that co-exists with a primary illness-is common among older persons with heart failure and can complicate the overall management of this population. OBJECTIVES: To determine the relationship between advancing age and the prevalence and patterns of comorbidity among older persons with heart failure. DESIGN: Retrospective longitudinal cohort study PARTICIPANTS: A total of 201,130 Medicare beneficiaries with heart failure stratified into three age strata in 2001: 66-75, 76-85, and 86+ years, and followed over 5 years. MEASUREMENTS: (1) Prevalence of 19 conditions as identified by the Chronic Conditions Warehouse fromMedicare claims data, characterized as concordant (related to heart failure) or discordant (unrelated to heart failure), and (2) overall comorbidity burden, defined as count of conditions. RESULTS: The median number of comorbidities rose from four (IQR: 2-5) to five (IQR: 4-7) among the youngold, and from 4 (IQR: 3-6) to 6 (IQR: 5-8) among the middle-old and oldest-old between 2001 and 2006. In 2001, the majority of concordant conditions were more prevalent among the youngest than oldest beneficiaries (e.g., diabetes 46.2% vs 26.9%; kidney disease 21.8% vs 18.4%), while the majority of discordant conditions were more prevalent among the oldest-old than youngest-old beneficiaries (e.g., dementia 39.6% vs 9.9%; hip fracture 9.5% vs 1.9%). Discordant conditions increased in prevalence faster among the oldest than youngest beneficiaries (e.g., dementia 13% points versus 9% points). CONCLUSION: Among older Medicare beneficiaries with heart failure, there is a higher overall burden of comorbidity and greater prevalence of discordant comorbidity among the oldest old. Comorbidity prevalence increases over time, with discordant comorbidity increasing at the fastest rate among the oldest old. This comorbidity burden highlights the challenge of effectively treating heart failure while simultaneously managing co-existing and unrelated conditions.

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Anemia and Outcomes in Patients With Heart Failure

Kosiborod¹,

Curtis²,

Wang³

et al. 2005

Arch Intern Med

120

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Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure

Cited by 670 publications

References 34 publications

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness

Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure

Anemia and Outcomes in Patients With Heart Failure

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