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Multimorbidity in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis
Jonathan A Batty1, Tamara Del Toro1, Daniel J Drayton2
1Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom; Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom.
Insights
Multimorbidity is prevalent in acute coronary syndrome (ACS) patients, affecting nearly half of individuals. This condition leads to less guideline-directed care and worse survival rates, highlighting a critical area for improved patient management.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Multimorbidity, the presence of multiple long-term conditions, complicates the management of acute coronary syndrome (ACS).
- Understanding the prevalence and impact of multimorbidity in ACS is crucial for optimizing patient care and outcomes.
Purpose of the Study:
- To determine the prevalence of multimorbidity in patients with ACS.
- To assess how multimorbidity influences the clinical management and outcomes of ACS patients.
Main Methods:
- A systematic review and meta-analysis of studies published up to July 2024.
- Searched Medline, Web of Science, Embase, and Cochrane databases.
- Included studies reporting multimorbidity prevalence in ACS or stratified ACS outcomes by multimorbidity status; employed random-effects meta-analysis.
Main Results:
- Pooled prevalence of multimorbidity in ACS was 46.6% (95% CI: 38.9%-54.2%) across 41 studies.
- Multimorbidity was linked to reduced use of invasive management and secondary preventative medications.
- Associated with increased short-term (RR 1.43) and long-term mortality (RR 1.87), with each additional condition increasing mortality risk by 16%.
Conclusions:
- Multimorbidity is a common condition in ACS patients.
- Patients with multimorbidity receive less guideline-directed therapy.
- Multimorbidity significantly worsens clinical outcomes and survival in ACS patients.
Background:
Multimorbidity (the presence of multiple long-term conditions) increases the complexity of management decisions for patients presenting with acute coronary syndrome (ACS).
Objectives:
The purpose of this study was to ascertain the prevalence of multimorbidity in ACS and assess its impact on clinical management and outcomes.
Methods:
Medline, Web of Science, Embase, and Cochrane were searched to July 2024 for studies that reported: 1) the prevalence of multimorbidity in patients with incident ACS or 2) ACS management and/or clinical outcomes, stratified by multimorbidity status. Random-effects meta-analysis was performed to calculate pooled summary statistics and was supported by narrative synthesis.
Results:
Overall, 41 studies were included. Those at low risk of bias (23 studies; npooled = 9,227,657) demonstrated a pooled prevalence of multimorbidity of 46.6% (95% CI: 38.9%-54.2%). Study-level determinants of prevalence included study setting (high-income: 48.5% [40.5%-56.5%] vs low- to middle-income countries: 35.3 [30.5%-40.3%]); P = 0.006) and the number of conditions in the per-study definition of multimorbidity (R2 = 79.6%; P < 0.001). Individual-level determinants of multimorbidity included advanced age, non-ST-segment elevation presentation, previous cardiac procedures, and greater body mass index. Multimorbidity was associated with reduced usage of invasive management and secondary preventative medication. Multimorbidity was associated with short-term mortality (≤30 day; relative risk [RR]pooled 95% CI: 1.43 [95% CI: 1.14-1.78]; P < 0.01) and longer-term mortality (>30 day; RRpooled: 1.87 [95% CI: 1.51-2.32]; P < 0.01). Each additional pre-existing long-term condition was associated with a 16% excess risk of mortality (RRpooled: 1.16 [95% CI: 1.06-1.26]; P < 0.01).
Conclusions:
Multimorbidity is common, associated with reduced use of guideline-directed therapies and adverse clinical outcomes in patients with ACS. (The prevalence of multimorbidity and its impact on clinical outcomes in patients with acute myocardial infarction: a systematic review and meta-analysis; CRD42023447122).
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