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Multimorbidity and risk among patients with established cardiovascular disease: a cohort study

Liam G Glynn1, Brian Buckley, Donal Reddan

  • 1Department of General Practice, National University of Ireland, Galway, Ireland. liam.glynn@nuigalway.ie

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
|July 10, 2008
PubMed

Insights

High multimorbidity significantly increases mortality and cardiovascular events in patients with established cardiovascular disease. Chronic kidney disease and diabetes present similar mortality risks, highlighting multimorbidity

Area of Science:

  • Cardiology
  • Nephrology
  • Endocrinology
  • Primary Care Medicine

Background:

  • Multimorbidity is common in primary care, complicating patient management and risk assessment.
  • Managing patients with multiple chronic conditions presents significant challenges for healthcare providers.
  • Established cardiovascular disease often coexists with other chronic conditions like diabetes and kidney disease.

Purpose of the Study:

  • To investigate the impact of chronic kidney disease and diabetes on mortality and morbidity in patients with existing cardiovascular disease.
  • To assess the independent prognostic value of multimorbidity in patients with cardiovascular disease.

Main Methods:

  • Retrospective cohort study involving 1609 patients with established cardiovascular disease.
  • Data collected from 35 general practices in the west of Ireland, with a 5-year follow-up period.
  • Primary endpoint: all-cause mortality. Secondary endpoint: cardiovascular composite endpoint (cardiovascular death, myocardial infarction, heart failure, peripheral vascular disease, stroke).

Main Results:

  • Increased multimorbidity was significantly associated with higher risks of all-cause mortality and the cardiovascular composite endpoint (P<0.001).
  • Patients with cardiovascular disease and diabetes showed similar survival to those with cardiovascular disease and chronic kidney disease.
  • The presence of diabetes led to more cardiovascular events compared to chronic kidney disease in patients with cardiovascular disease.

Conclusions:

  • The level of multimorbidity independently predicts prognosis in patients with established cardiovascular disease.
  • Chronic kidney disease and diabetes confer similar mortality risks in patients with cardiovascular disease.
  • Multimorbidity can be a valuable factor for prioritizing patient management in community settings with high cardiovascular risk.
Abstract

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