Comorbidity and polypharmacy in chronic heart failure: a large cross-sectional study in primary care

Baron-Franco, B., Mclean, G., Mair, F. S. , Roger, V. L., Guthrie, B. and Mercer, S. W. (2017) Comorbidity and polypharmacy in chronic heart failure: a large cross-sectional study in primary care. British Journal of General Practice, (doi:10.3399/bjgp17X690533) (PMID:28396366) (Early Online Publication)

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Abstract

Background: Comorbidity is common in heart failure, but previous prevalence estimates have been based on a limited number of conditions using mainly non-primary care data sources. Aim: To compare prevalence rates of comorbidity and polypharmacy in those with and without chronic heart failure due to left ventricular systolic dysfunction (LVSD). Design and setting: A cross-sectional study of 1.4 million patients in primary care in Scotland. Method: Data on the presence of LVSD, 31 other physical, and seven mental health comorbidities, and prescriptions were extracted from a database of 1 424 378 adults. Comorbidity prevalence was compared in patients with and without LVSD, standardised by age, sex, and deprivation. Pharmacology data were also compared between the two groups. Results: There were 17 285 patients (1.2%) who had a diagnosis of LVSD. Compared with standardised controls, the LVSD group had greater comorbidity, with the biggest difference found for seven or more conditions (odds ratio [OR] 4.10; 95% confidence interval (CI] = 3.90 to 4.32). Twenty-five physical conditions and six mental health conditions were significantly more prevalent in those with LVSD relative to standardised controls. Polypharmacy was higher in the LVSD group compared with controls, with the biggest difference found for ≥11 repeat prescriptions (OR 4.81; 95% CI = 4.60 to 5.04). However, these differences in polypharmacy were attenuated after controlling for the number of morbidities, indicating that much of the additional prescribing was accounted for by multimorbidity rather than LVSD per se. Conclusion: Extreme comorbidity and polypharmacy is significantly more common in patients with chronic heart failure due to LVSD. The efficient management of such complexity requires the integration of general and specialist expertise.

Item Type:Articles
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mercer, Professor Stewart and Mair, Professor Frances and McLean, Dr Gary
Authors: Baron-Franco, B., Mclean, G., Mair, F. S., Roger, V. L., Guthrie, B., and Mercer, S. W.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Journal Name:British Journal of General Practice
Publisher:Royal College of General Practitioners
ISSN:0960-1643
ISSN (Online):1478-5242
Published Online:11 April 2017
Copyright Holders:Copyright © 2017 Royal College of General Practitioners
First Published:First published in British Journal of General Practice 2017
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
477971Living Well with Multiple MorbidityStewart MercerScottish Executive Health Department (SEHHD-CSO)ARPG/07/1IHW - GENERAL PRACTICE & PRIMARY CARE