Increasing multimorbidity levels (≥6 vs 0-1 comorbidities) in heart failure patients were associated with a higher likelihood of being prescribed HF-exacerbating drugs (OR 5.2; 95% CI 4.7-5.7).
Cohort (n=34,730)
No
Does increasing multimorbidity increase the risk of one-year all-cause mortality and prescription of HF-exacerbating drugs in patients with heart failure?
Heart failure patients are presenting with increasing age and multimorbidity, which is associated with higher rates of HF-exacerbating drug prescriptions and one-year mortality, though the mortality risk has declined over time.
Effect estimate: OR 5.2 (95% CI 4.7-5.7)
Abstract Background Multimorbidity frequently complicates the management of heart failure (HF). Yet comprehensive large-scale contemporary reports of patterns and trends of multimorbidity in patients with HF are limited. Purpose Therefore, we investigated the temporal trends of multimorbidity, and its association with treatment approaches, and one-year all-cause mortality. Methodology This retrospective study analysed electronic health records (EHR) from one of the three regional health systems in a developed Southeast Asian country. The study population comprised patients with primary or secondary HF diagnosis between 1st January 2008 and 31st December 2022. Temporal trends in baseline characteristics and 37 comorbidities, diagnosed before or on the index diagnosis of HF (first recorded in the EHR) described over four periods: 2008-2011, 2012-2015, 2016-2019, and 2020-2022. Multimorbidity was categorised by the number of chronic conditions (0-1, 2-3, 4-5 and ≥6). Logistic regression assessed the associations between multimorbidity levels and HF-exacerbating drug prescription at HF diagnosis. Cox regression evaluated the impact of multimorbidity on one-year all-cause mortality. All models were adjusted for age, gender, ethnicity, and guideline-directed medical therapy. Results This study included 34,730 patients with HF. Between 2008 and 2022, patients at first HF diagnosis were increasingly older (from 69 ±14 to 71 ±14 years), predominantly men (from 52% to 57%), and presented with greater multimorbidity. The prevalence of multimorbidity (≥2 comorbidities) rose from 70.5% to 95.1%. between 2008-2011 and 2020-2022 (Figure 1A). The increase in multimorbidity was primarily driven by an increased prevalence of cardiometabolic, renal, liver, anemia, and musculoskeletal conditions (Figure 1B). At first HF diagnosis, patients with increasing multimorbidity levels were more likely to be prescribed HF-exacerbating drugs compared to those with 0-1 comorbidities (2-3: OR 2.1, 95% CI: 1.9-2.4; 4-5: OR: 2.6, 95% CI: 2.4-2.9 and ≥6: OR: 5.2, 95% CI: 4.7-5.7). Increasing multimorbidity levels were associated with a higher risk of one-year all-cause mortality, though this effect decreased over time (Table 1). Conclusion Using a large-scale, contemporaneous cohort, this study highlights the increasing complexity of patients with HF, who are older and present with greater multimorbidity at diagnosis. While higher multimorbidity levels were associated with an increased risk of death, this risk declined over time, potentially reflecting advancements in HF management. Optimizing HF care amid rising multimorbidity requires refining treatment strategies, balancing guideline-directed therapy while minimizing HF-exacerbating drugs and shifting to holistic cardiovascular care.Figure 1 Table 1
Kaur et al. (Sat,) conducted a cohort in Heart failure (n=34,730). Increasing multimorbidity levels (≥6 comorbidities) vs. 0-1 comorbidities was evaluated on Prescription of HF-exacerbating drugs at HF diagnosis (OR 5.2, 95% CI 4.7-5.7). Increasing multimorbidity levels (≥6 vs 0-1 comorbidities) in heart failure patients were associated with a higher likelihood of being prescribed HF-exacerbating drugs (OR 5.2; 95% CI 4.7-5.7).