Common non‐cardiovascular multimorbidity groupings and clinical outcomes in older adults with major cardiovascular disease

Abstract

AbstractBackgroundAmong 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).MethodsUsing 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.ResultsSimilar 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.ConclusionFour 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.