Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: Latent class analysis of a nationwide population-based cohort

Autor: Hall, M, Dondo, TB, Yan, AT, Mamas, MA, Timmis, AD, Deanfield, JE, Jernberg, T, Hemingway, H, Fox, KAA, Gale, CP
Přispěvatelé: Lam, CSP
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: PLoS Medicine, Vol 15, Iss 3, p e1002501 (2018)
Hall, M, Dondo, T B, Yan, A T, Mamas, M A, Timmis, A D, Deanfield, J E, Jernberg, T, Hemingway, H, Fox, K A A & Gale, C P 2018, ' Multimorbidity and survival for patients with acute myocardial infarction in England and Wales : Latent class analysis of a nationwide population-based cohort ', PLoS Medicine, vol. 15, no. 3, pp. e1002501 . https://doi.org/10.1371/journal.pmed.1002501
PLoS Medicine
ISSN: 1549-1676
1549-1277
Popis: Background There is limited knowledge of the scale and impact of multimorbidity for patients who have had an acute myocardial infarction (AMI). Therefore, this study aimed to determine the extent to which multimorbidity is associated with long-term survival following AMI. Methods and findings This national observational study included 693,388 patients (median age 70.7 years, 452,896 [65.5%] male) from the Myocardial Ischaemia National Audit Project (England and Wales) who were admitted with AMI between 1 January 2003 and 30 June 2013. There were 412,809 (59.5%) patients with multimorbidity at the time of admission with AMI, i.e., having at least 1 of the following long-term health conditions: diabetes, chronic obstructive pulmonary disease or asthma, heart failure, renal failure, cerebrovascular disease, peripheral vascular disease, or hypertension. Those with heart failure, renal failure, or cerebrovascular disease had the worst outcomes (39.5 [95% CI 39.0–40.0], 38.2 [27.7–26.8], and 26.6 [25.2–26.4] deaths per 100 person-years, respectively). Latent class analysis revealed 3 multimorbidity phenotype clusters: (1) a high multimorbidity class, with concomitant heart failure, peripheral vascular disease, and hypertension, (2) a medium multimorbidity class, with peripheral vascular disease and hypertension, and (3) a low multimorbidity class. Patients in class 1 were less likely to receive pharmacological therapies compared with class 2 and 3 patients (including aspirin, 83.8% versus 87.3% and 87.2%, respectively; β-blockers, 74.0% versus 80.9% and 81.4%; and statins, 80.6% versus 85.9% and 85.2%). Flexible parametric survival modelling indicated that patients in class 1 and class 2 had a 2.4-fold (95% CI 2.3–2.5) and 1.5-fold (95% CI 1.4–1.5) increased risk of death and a loss in life expectancy of 2.89 and 1.52 years, respectively, compared with those in class 3 over the 8.4-year follow-up period. The study was limited to all-cause mortality due to the lack of available cause-specific mortality data. However, we isolated the disease-specific association with mortality by providing the loss in life expectancy following AMI according to multimorbidity phenotype cluster compared with the general age-, sex-, and year-matched population. Conclusions Multimorbidity among patients with AMI was common, and conferred an accumulative increased risk of death. Three multimorbidity phenotype clusters that were significantly associated with loss in life expectancy were identified and should be a concomitant treatment target to improve cardiovascular outcomes. Trial registration ClinicalTrials.gov NCT03037255.
Using latent class analysis, Marlous Hall and colleagues examine the associations between mulitmorbidity and survival in patients with acute myocardial infarction.
Author summary Why was this study done? Survival following a heart attack (acute myocardial infarction) has improved over recent decades. The population is ageing, and there are more patients living longer with multiple long-term health conditions (multimorbidity). Previous studies have looked at the associations between individual long-term health conditions and survival following a heart attack, but little is known about patterns of multiple conditions and how such multimorbidity patterns may be associated with patients’ outcomes. What did the researchers do and find? A total of 693,388 patients who had a heart attack between 2003 and 2013 across England and Wales were included in the study. 59.5% of patients had at least 1 of the following long-term health conditions at the time of their heart attack: diabetes, chronic obstructive pulmonary disease or asthma, heart failure, renal failure, cerebrovascular disease (stroke), peripheral vascular disease, or hypertension. There were 3 common multimorbidity patient groups: (1) patients with high multimorbidity at the time of their heart attack, who tended to have heart failure as well as peripheral vascular disease and hypertension, (2) patients with medium multimorbidity at the time of their heart attack, who tended to have peripheral vascular disease and hypertension, and (3) patients with few co-morbidities. Patients who had high and medium levels of multimorbidity had average reduced life expectancies of 2.9 and 1.5 years, respectively, compared with patients who had few co-morbidities. What do these findings mean? This study shows that many patients with a heart attack have multimorbidity, and that those with high and medium levels of multimorbidity are likely to experience a significant reduction in years of life expectancy. Whilst this study included 7 conditions most commonly occurring in patients who have a heart attack, there may be other conditions including dementia and cancer that require investigation in this context. Future research should focus on developing treatment guidelines for the multimorbidity patient groups identified to improve outcomes for heart attack patients with multimorbidity.
Databáze: OpenAIRE
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