Abstract
Background The presence of multiple comorbidities in an elderly patient can make clinical decision-making and disease management challenging, and may increase the risk for adverse outcomes including unnecessary hospitalizations, adverse drug events, and functional decline. Approximately one half of patients with HF have at least one additional comorbid condition present. Despite the increasing prevalence of multiple comorbidities in patients with HF, data are lacking on whether various comorbidities of HF cluster together, and whether certain clusters of comorbidities are associated with adverse clinical outcomes in these high risk patients.
Methods The study population includes 37,823 patients in the CVRN PRESERVE cohort, a multicenter cohort of patients with HF diagnosed between 2005 and 2008, that is currently being conducted at 4 CVRN sites: Kaiser Permanente of Northern California, Kaiser Permanente Colorado, Kaiser Permanente Northwest and Fallon Community Health Plan/Meyers. Approximately 46% of the cohort is female and 78% are >65 years old.
Results The prevalence of specific comorbidities range from low [e.g., ischemic stroke, 5.3% (2,004 of 37,823); TIA, 4.0% (1,500 of 37,823)] to moderate or high [e.g., cognitive impairment/dementia, 12.4% (4,678 of 37,823); hypertension, 48.4% (18,311 of 37,823)]. We will characterize the patterns of comorbidity using cluster analysis. Cluster analysis is a novel approach to examining the co-occurrence of multiple comorbidities that goes beyond traditional indices, such as the Charlson and Elixhauser, that simply count diseases. Examples of clusters that may be present in patients with HF are: cardiopulmonary (e.g., coronary heart disease, COPD), circulatory (e.g., hypertension, atrial fibrillation), sensory-motor (deafness and visual impairment) and neurological (e.g., dementia, depression). We will describe the demographic characteristics of high frequency clusters and examine whether patterns of comorbidity vary according to whether HF is with or without preserved left ventricular systolic function.
Conclusions Future work in this cohort will examine the association between patterns of comorbidity clusters and use of selected HF-related therapies, early physician follow-up among those hospitalized for HF, and rehospitalization in the 1- and 6-month periods after hospital discharge.
