Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore

Publication Date:
2018-05-22
Publisher:
BMJ Publishing
Electronic ISSN:
2044-6055
Topics:
Medicine
Keywords:
Open access, Health services research
Published by:
_version_ 1836398939200290816
autor Kaur, P., Saxena, N., You, A. X., Wong, R. C. C., Lim, C. P., Loh, S. Y., George, P. P.
beschreibung 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.
citation_standardnr 6263419
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insertion_date 2018-05-22
journaleissn 2044-6055
publikationsjahr_anzeige 2018
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publikationsjahr_intervall 7984:2015-2019
publikationsjahr_sort 2018
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relation http://bmjopen.bmj.com/cgi/content/short/8/5/e021291?rss=1
schlagwort Open access, Health services research
search_space articles
shingle_author_1 Kaur, P., Saxena, N., You, A. X., Wong, R. C. C., Lim, C. P., Loh, S. Y., George, P. P.
shingle_author_2 Kaur, P., Saxena, N., You, A. X., Wong, R. C. C., Lim, C. P., Loh, S. Y., George, P. P.
shingle_author_3 Kaur, P., Saxena, N., You, A. X., Wong, R. C. C., Lim, C. P., Loh, S. Y., George, P. P.
shingle_author_4 Kaur, P., Saxena, N., You, A. X., Wong, R. C. C., Lim, C. P., Loh, S. Y., George, P. P.
shingle_catch_all_1 Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
Open access, Health services research
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.
Kaur, P., Saxena, N., You, A. X., Wong, R. C. C., Lim, C. P., Loh, S. Y., George, P. P.
BMJ Publishing
2044-6055
20446055
shingle_catch_all_2 Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
Open access, Health services research
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.
Kaur, P., Saxena, N., You, A. X., Wong, R. C. C., Lim, C. P., Loh, S. Y., George, P. P.
BMJ Publishing
2044-6055
20446055
shingle_catch_all_3 Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
Open access, Health services research
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.
Kaur, P., Saxena, N., You, A. X., Wong, R. C. C., Lim, C. P., Loh, S. Y., George, P. P.
BMJ Publishing
2044-6055
20446055
shingle_catch_all_4 Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
Open access, Health services research
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.
Kaur, P., Saxena, N., You, A. X., Wong, R. C. C., Lim, C. P., Loh, S. Y., George, P. P.
BMJ Publishing
2044-6055
20446055
shingle_title_1 Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
shingle_title_2 Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
shingle_title_3 Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
shingle_title_4 Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
timestamp 2025-06-30T23:35:00.448Z
titel Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
titel_suche Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
topic WW-YZ
uid ipn_articles_6263419