Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
| Autor: | Choon Pin Lim, Seet Yoong Loh, Raymond Ching-Chiew Wong, Pradeep Paul George, Nakul Saxena, Palvinder Kaur, Alex Xiaobin You |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Databases Factual heart failure Disease 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Risk Factors Diabetes mellitus Internal medicine Cause of Death medicine multi-morbidity Humans 030212 general & internal medicine Disease management (health) Renal Insufficiency Chronic Aged Retrospective Studies Aged 80 and over Singapore Primary Health Care diabetes Proportional hazards model business.industry Public health Research Multimorbidity Retrospective cohort study General Medicine Middle Aged medicine.disease Survival Analysis mortality Diabetes Mellitus Type 2 Cardiovascular Diseases Heart failure Female Health Services Research business chronic kidney disease Kidney disease |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | Objective Multimorbidity in patients with heart failure (HF) results in poor prognosis and is an increasing public health concern. We aim to examine the effect of multimorbidity focusing on type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) on all-cause and cardiovascular disease (CVD)-specific mortality among patients diagnosed with HF in Singapore. Design Retrospective cohort study. Setting Primary and tertiary care in three (out of six) Regional Health Systems in Singapore. Participants Patients diagnosed with HF between 2003 and 2016 from three restructured hospitals and nine primary care polyclinics were included in this retrospective cohort study. Primary outcomes All-cause mortality and CVD-specific mortality. Results A total of 34 460 patients diagnosed with HF from 2003 to 2016 were included in this study and were followed up until 31 December 2016. The median follow-up time was 2.1 years. Comorbidities prior to HF diagnosis were considered. Patients were categorised as (1) HF only, (2) T2DM+HF, (3) CKD+HF and (4) T2DM+CKD+HF. Cox regression model was used to determine the effect of multimorbidity on (1) all-cause mortality and (2) CVD-specific mortality. Adjusting for demographics, other comorbidities, baseline treatment and duration of T2DM prior to HF diagnosis, ‘T2DM+CKD+HF’ patients had a 56% higher risk of all-cause mortality (HR: 1.56, 95% CI 1.48 to 1.63) and a 44% higher risk of CVD-specific mortality (HR: 1.44, 95% CI 1.32 to 1.56) compared with patients diagnosed with HF only. Conclusion All-cause and CVD-specific mortality risks increased with increasing multimorbidity. This study highlights the need for a new model of care that focuses on holistic patient management rather than disease management alone to improve survival among patients with HF with multimorbidity. |
| Databáze: | OpenAIRE |
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