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

Bosco Baron-Franco, Gary McLean, Frances S. Mair, Veronique Lee Roger, Bruce Guthrie, Stewart W. Mercer

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)e314-e320
JournalBritish Journal of General Practice
Volume67
Issue number658
DOIs
StatePublished - May 1 2017

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Polypharmacy
Left Ventricular Dysfunction
Comorbidity
Primary Health Care
Heart Failure
Cross-Sectional Studies
Prescriptions
Mental Health
Odds Ratio
Information Storage and Retrieval
Scotland
Databases
Pharmacology
Confidence Intervals
Morbidity

Keywords

  • Comorbidity
  • General Practice
  • Heart failure
  • Multimorbidity
  • Polypharmacy

ASJC Scopus subject areas

  • Family Practice

Cite this

Comorbidity and polypharmacy in chronic heart failure : A large cross-sectional study in primary care. / Baron-Franco, Bosco; McLean, Gary; Mair, Frances S.; Roger, Veronique Lee; Guthrie, Bruce; Mercer, Stewart W.

In: British Journal of General Practice, Vol. 67, No. 658, 01.05.2017, p. e314-e320.

Research output: Contribution to journalArticle

Baron-Franco, Bosco ; McLean, Gary ; Mair, Frances S. ; Roger, Veronique Lee ; Guthrie, Bruce ; Mercer, Stewart W. / Comorbidity and polypharmacy in chronic heart failure : A large cross-sectional study in primary care. In: British Journal of General Practice. 2017 ; Vol. 67, No. 658. pp. e314-e320.
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