Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore
Kaur, P., Saxena, N., You, A. X., Wong, R. C. C., Lim, C. P., Loh, S. Y., George, P. P.
BMJ Publishing
Published 2018
BMJ Publishing
Published 2018
| 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 |
| datenlieferant | ipn_articles |
| feed_id | 151627 |
| feed_publisher | BMJ Publishing |
| feed_publisher_url | http://group.bmj.com/ |
| insertion_date | 2018-05-22 |
| journaleissn | 2044-6055 |
| publikationsjahr_anzeige | 2018 |
| publikationsjahr_facette | 2018 |
| publikationsjahr_intervall | 7984:2015-2019 |
| publikationsjahr_sort | 2018 |
| publisher | BMJ Publishing |
| quelle | BMJ Open |
| 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 |