Common non‐cardiovascular multimorbidity groupings and clinical outcomes in older adults with major cardiovascular disease.
Background: Among older adults, non‐cardiovascular multimorbidity often coexists with cardiovascular disease (CVD) but their clinical significance is uncertain. We identified common non‐cardiovascular comorbidity patterns and their association with clinical outcomes in Medicare fee‐for‐service benef...
| Publicado en: | Journal of the American Geriatrics Society Vol. 71; no. 10; pp. 3179 - 3189 |
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| Autores principales: | , , , , , , , |
| Formato: | Artículo |
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Wiley-Blackwell
Oct2023
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=172913285&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 172913285 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00028614 20Q jtl: Journal of the American Geriatrics Society issn: 00028614 maglogo: Y pubinfo: dt: Oct2023 vid: 71 iid: 10 pid: 480 pub: Wiley-Blackwell artinfo: ui: 172913285 10.1111/jgs.18479 ppf: 3179 ppct: 10 formats: tig: atl: Common non‐cardiovascular multimorbidity groupings and clinical outcomes in older adults with major cardiovascular disease. aug: au: Sison, Stephanie Denise M. Lin, Kueiyu Joshua Najafzadeh, Mehdi Ko, Darae Patorno, Elisabetta Bessette, Lily G. Zakoul, Heidi Kim, Dae Hyun affil: Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston Massachusetts,, USA Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston Massachusetts,, USA Department of Internal Medicine, University of Massachusetts Chan Medical School, Worcester Massachusetts,, USA Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston Massachusetts,, USA Section of Cardiovascular Medicine, Boston University School of Medicine, Boston Massachusetts,, USA su: Mortality Hospital care Medicare Old age Fee for service (Medical fees) Structural equation modeling Cardiovascular diseases Myocardial infarction Atrial fibrillation Treatment effectiveness Research funding Statistical sampling Comorbidity Heart failure Evaluation sug: subj: Mortality Hospital care Medicare Old age Administration of Human Resource Programs (except Education, Public Health, and Veterans' Affairs Programs) Marketing Research and Public Opinion Polling Fee for service (Medical fees) Structural equation modeling Cardiovascular diseases Myocardial infarction Atrial fibrillation Treatment effectiveness Research funding Statistical sampling Comorbidity Heart failure Evaluation keyword: atrial fibrillation comorbidity heart failure latent class analysis myocardial infarction atrial fibrillation comorbidity heart failure latent class analysis myocardial infarction ab: Background: Among older adults, non‐cardiovascular multimorbidity often coexists with cardiovascular disease (CVD) but their clinical significance is uncertain. We identified common non‐cardiovascular comorbidity patterns and their association with clinical outcomes in Medicare fee‐for‐service beneficiaries with acute myocardial infarction (AMI), congestive heart failure (CHF), or atrial fibrillation (AF). Methods: Using 2015–2016 Medicare data, we took 1% random sample to create 3 cohorts of beneficiaries diagnosed with AMI (n = 24,808), CHF (n = 57,285), and AF (n = 36,277) prior to 1/1/2016. Within each cohort, we applied latent class analysis to classify beneficiaries based on 9 non‐cardiovascular comorbidities (anemia, cancer, chronic kidney disease, chronic lung disease, dementia, depression, diabetes, hypothyroidism, and musculoskeletal disease). Mortality, cardiovascular and non‐cardiovascular hospitalizations, and home time lost over a 1‐year follow‐up period were compared across non‐cardiovascular multimorbidity classes. Results: Similar non‐cardiovascular multimorbidity classes emerged from the 3 CVD cohorts: (1) minimal, (2) depression‐lung, (3) chronic kidney disease (CKD)‐diabetes, and (4) multi‐system class. Across CVD cohorts, multi‐system class had the highest risk of mortality (hazard ratio [HR], 2.7–3.9), cardiovascular hospitalization (HR, 1.6–3.3), non‐cardiovascular hospitalization (HR, 3.1–7.2), and home time lost (rate ratio, 2.7–5.4). Among those with AMI, the CKD‐diabetes class was more strongly associated with all the adverse outcomes than the depression‐lung class. In CHF and AF, differences in risk between the depression‐lung and CKD‐diabetes classes varied per outcome; and the depression‐lung and multi‐system classes had double the rates of non‐cardiovascular hospitalizations than cardiovascular hospitalizations. Conclusion: Four non‐cardiovascular multimorbidity patterns were found among Medicare beneficiaries with CHF, AMI, or AF. Compared to the minimal class, the multi‐system, CKD‐diabetes, and depression‐lung classes were associated with worse outcomes. Identification of these classes offers insight into specific segments of the population that may benefit from more than the usual cardiovascular care. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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