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Patterns of comorbidity in older adults with heart failure: the Cardiovascular Research Network PRESERVE study
Jane S Saczynski1, Alan S Go, David J Magid
1Meyers Primary Care Institute and Fallon Community Health Plan, Worcester, Massachusetts 01605, USA. Jane.saczynski@umassmed.edu
Insights
Individuals with heart failure (HF) experience significant comorbidity. The total burden and pattern of co-occurring conditions show minimal variation between heart failure with preserved ejection fraction (HF-P) and heart failure with reduced ejection fraction (HF-R).
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Epidemiology
Background:
- Heart failure (HF) is a complex condition often accompanied by multiple comorbidities.
- Understanding comorbidity patterns in different HF subtypes, specifically HF with preserved ejection fraction (HF-P) versus HF with reduced ejection fraction (HF-R), is crucial for effective management.
Observation:
- A cross-sectional study analyzed 23,435 individuals aged 65+ with HF.
- Over three-quarters had at least three comorbidities, and half had five or more, indicating high overall comorbidity burden.
- Participants with HF-P exhibited a slightly higher mean comorbidity count (4.5) compared to HF-R (4.4).
Findings:
- The overall burden of comorbidity was high in both HF-P and HF-R groups.
- Patterns of co-occurring conditions did not significantly differ between HF-P and HF-R.
- These findings suggest that while HF patients generally have numerous comorbidities, the specific LVEF status has a minor impact on the comorbidity profile.
Implications:
- Clinical management strategies for HF should comprehensively address the high burden of multiple comorbidities.
- The minimal differences in comorbidity burden and patterns between HF-P and HF-R suggest a need for integrated care approaches.
- Further research could explore the impact of specific comorbidity constellations on HF outcomes.
Objectives:
To examine whether the total burden of comorbidity and pattern of co-occurring conditions varies in individuals with heart failure (HF) with preserved left ventricular ejection fraction (LVEF) (HF-P) or HF with reduced LVEF (HF-R).
Design:
Cross-sectional cohort study.
Setting:
Four participating health plans within the National Heart, Lung, and Blood Institute-sponsored Cardiovascular Research Network.
Participants:
All members aged 65 and older with HF based on hospital discharge and ambulatory visit diagnoses.
Measurements:
Participants with a LVEF of 50% or greater were classified as having HF-P. Presence of cardiac and noncardiac comorbidities was obtained from health plan administrative databases.
Results:
Of 23,435 individuals identified with HF and LVEF information, 53% (12,407) had confirmed HF-P (mean age 79.6; 60% female). More than three-quarters of the sample had three or more co-occurring conditions in addition to HF, and half had five or more cooccurring conditions. Participants with HF-P had a slightly higher burden of comorbidity than those with HF-R (mean 4.5 vs 4.4, P = .002). Patterns of how specific conditions co-occurred did not vary in participants with preserved or reduced systolic function.
Conclusion:
There is a high degree of comorbidity and multiple morbidity in individuals with HF. The burden and pattern of comorbidity varies only slightly in individuals with preserved or reduced LVEF.
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