Approach to Multimorbidity Burden Classification and Outcomes in Older Adults With Heart Failure

Bibliographic Data

ID9103071
AuthorsMayra Tisminetzky (0000-0002-8557-2029, Meyers Health Care Institute, a Joint Endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, corresponding author), Jerry H Gurwitz (0000-0003-1630-8213, Meyers Health Care Institute, a Joint Endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, corresponding author), Grace Tabada (Division of Research, Kaiser Permanente Northern California, Oakland), Grace H Tabada (Kaiser Permanente), Kristi Reynolds (0000-0001-7619-1649, Department of Research and Evaluation, Kaiser Permanente Southern California), David H Smith (0000-0001-7184-8947, Center for Health Research, Kaiser Permanente Northwest, Portland Oregon, OR), Sue Hee Sung (Division of Research, Kaiser Permanente Northern California, Oakland), Richard J Goldberg (0000-0001-7705-7740, University of Massachusetts Chan Medical School, corresponding author), Robert Goldberg (Meyers Health Care Institute, a Joint Endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health), Alan S Go (0000-0001-9109-0811, Division of Research, Kaiser Permanente Northern California, Oakland, corresponding author)
Year2023
Volume61
Issue5
Pages268-278
Publication date2023-05-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001828
PMID36920167
OpenAlexW4324305932
LanguageEN
References cited36

BACKGROUND: The optimal approach to classifying multimorbidity burden in assessing treatment-associated outcomes using real-world data remains uncertain. We assessed whether 2 measurement approaches to characterize multimorbidity influenced observed associations of β-blocker use with outcomes in adults with heart failure (HF). METHODS: We conducted a retrospective study on adults with HF from 4 integrated health care delivery systems. Multimorbidity burden was characterized by either (1) simple counts of chronic conditions or (2) a weighted multiple chronic conditions score using data from electronic health records. We assessed the impact of these 2 approaches to characterizing multimorbidity on associations between exposure to β-blockers and subsequent all-cause death, hospitalization for HF, and hospitalization for any cause. RESULTS: The study population characterized by a count of chronic conditions included 9988 adults with HF who had a mean (SD) age of 76.4 (12.5) years, with 48.7% women and 24.7% racial/ethnic minorities. The cohort characterized by weighted multiple chronic conditions included 10,082 adults with HF who had a mean (SD) age of 76.4 (12.4) years, 48.9% women, and 25.5% racial/ethnic minorities. The multivariable associations of risks of death or hospitalizations for HF or for any cause associated with incident β-blocker use were similar regardless of how multimorbidity burden was characterized. CONCLUSIONS: Simple counts of chronic conditions performed similarly to a weighted multimorbidity score in predicting outcomes using real-world data to examine clinical outcomes associated with β-blocker therapy in HF. Our findings challenge conventional wisdom that more complex measures of multimorbidity are always necessary to characterize patients in observational studies examining therapy-associated outcomes

Cohort · Cohort study · Comorbidity · Environmental health · Ethnic group · Health care · Heart failure · Multimorbidity · Population · Retrospective cohort study · Advanced Causal Inference Techniques · Chronic Disease Management Strategies · Heart Failure Treatment and Management · Internal Medicine · Medicine