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Multimorbidity in Patients With Acute Coronary Syndrome Is Associated With Greater Mortality, Higher Readmission
Katherine Breen1, Lorna Finnegan, Karen Vuckovic
1Katherine Breen, PhD, RN Clinical Faculty, University of Illinois at Chicago. Lorna Finnegan, PhD, RN, FAAN Professor, Loyola University Chicago, Illinois. Karen Vuckovic, PhD, RN Clinical Associate Professor, University of Illinois at Chicago. Anne Fink, PhD, RN Assistant Professor, University of Illinois at Chicago. Wayne Rosamond, PhD Professor, University of North Carolina, Chapel Hill. Holli A. DeVon, PhD, RN Professor, University of California Los Angeles.
Insights
Patients with multiple chronic conditions (multimorbidity) and acute coronary syndrome (ACS) face worse outcomes, including higher mortality and longer hospital stays. Research is needed to understand multimorbidity
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- Multimorbidity, defined as having two or more chronic conditions, is increasingly prevalent in patients with acute coronary syndrome (ACS).
- Understanding the impact of co-occurring cardiovascular and noncardiovascular conditions on ACS patient outcomes is critical for effective management.
Purpose of the Study:
- To systematically review the impact of multimorbidity on mortality, length of stay, and coronary intervention rates in patients with ACS.
- To compare the prevalence of cardiovascular versus noncardiovascular comorbidities in ACS patients.
- To assess disparities in evidence-based treatment delivery for multimorbid ACS patients.
Main Methods:
- A systematic review of studies published between 2009 and 2019 was conducted.
- Databases searched included MEDLINE, PubMed, MedlinePlus, EMBASE, OVID, and CINAHL.
- Eight original studies met inclusion criteria, with study quality assessed using the Crowe Critical Appraisal Tool.
Main Results:
- The prevalence of multimorbidity in ACS patients ranges from 25% to 95%.
- Multimorbid ACS patients experienced higher in-hospital mortality (5%-13.9% vs. 2.6%-6.1%) and longer hospital stays (5-9 days vs. 3-4 days).
- Multimorbid patients received fewer evidence-based treatments, including lower rates of coronary intervention (9%-14% vs. 39%-42%). Women exhibited higher levels of multimorbidity than men.
Conclusions:
- Multimorbid patients with ACS face significantly worse outcomes compared to their non-multimorbid counterparts.
- Inconsistent measurement of multimorbidity complicates interpretation and highlights the need for standardized assessment.
- Further research is required to investigate the effects of multimorbidity on post-discharge healthcare utilization.
Objective:
The aims of this systematic review were to determine the magnitude and impact of multimorbidity (≥2 chronic conditions) on mortality, length of stay, and rates of coronary intervention in patients with acute coronary syndrome (ACS) and to compare the prevalence of cardiovascular versus noncardiovascular multimorbidities.
Methods:
MEDLINE, PubMed, MedlinePlus, EMBASE, OVID, and CINAHL databases were searched for studies published between 2009 and 2019. Eight original studies enrolling patients with ACS and assessing cardiovascular and noncardiovascular comorbid conditions met the inclusion criteria. Study quality was evaluated using the Crowe Critical Appraisal Tool.
Results:
The most frequently examined cardiovascular multimorbidities included hypertension, diabetes, heart failure, atrial fibrillation, stroke/transient ischemic attack, coronary heart disease, and peripheral vascular disease; the most frequently examined noncardiovascular multimorbidities included cancer, anemia, chronic obstructive pulmonary disease, renal disease, liver disease, and depression. The prevalence of multimorbidity in the population with ACS is high (25%-95%). Patients with multimorbidities receive fewer evidence-based treatments, including coronary intervention and high-dose statins. Patients with multimorbidities experience higher in-hospital mortality (5%-13.9% vs 2.6%-6.1%), greater average length of stay (5-9 vs 3-4 days), and lower rates of revascularization (9%-14% vs 39%-42%) than nonmultimorbid patients. Women, despite being the minority in all sample populations, exhibited greater levels of multimorbidity than men.
Conclusions:
Multimorbid patients with ACS are at a greater risk for worse outcomes than their nonmultimorbid counterparts. Lack of consistent measurement makes interpretation of the impact of multimorbidity challenging and emphasizes the need for more research on multimorbidity's effects on postdischarge healthcare utilization.
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