Comorbidity phenotypes and risk of mortality in patients with ischaemic heart disease in the UK
Comorbidity phenotypes and risk of mortality in patients with ischaemic heart disease in the UK
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DOI：
10.1136/heartjnl-2019-316091
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发表时间：
2020-06-01
期刊：
影响因子：
5.7
通讯作者：
Marshall, Tom
中科院分区：
文献类型：
--
作者：
Crowe, Francesca;Zemedikun, Dawit T.;Marshall, Tom
ObjectivesThe objective of this study is to use latent class analysis of up to 20 comorbidities in patients with a diagnosis of ischaemic heart disease（IHD）to identify clusters of comorbidities and to examine the associations between these clusters and mortality.MethodsLongitudinal analysis of electronic health records in the health improvement network（THIN），一个英国初级保健数据库，包括92 186名男性和女性年龄>= 18岁的IHD和中位数为2（IQR 1-3）comorbidity.ResultsLatent类分析揭示了五个集群与一半归类为低负担comorbiditygroup。中位随访3.2（IQR 1.4-5.8）年后，17645例患者死亡。与低负担合并症组相比，两组合并症负担高的患者的死亡率校正HR最高：血管和肌肉骨骼疾病患者，HR 2.38（95% CI 2.28 - 2.49），呼吸和肌肉骨骼疾病患者，HR 2.62（95% CI 2.45 - 2.79）。其他两组患者的死亡风险特征为心脏代谢和精神健康共病，也高于低负荷共病组; HR 1.46（95% CI 1.39 - 1.52）和1.55（95%CI 1.46至1.64），结论：该分析确定了IHD患者的五种不同的合并症簇，它们与IHD患者的心血管疾病有不同的相关性。死亡风险。这些分析应该在其他大型数据集中复制，这可能有助于制定未来的干预措施或卫生服务，考虑到这些并发症集群的影响。
ObjectivesThe objective of this study is to use latent class analysis of up to 20 comorbidities in patients with a diagnosis of ischaemic heart disease (IHD) to identify clusters of comorbidities and to examine the associations between these clusters and mortality.MethodsLongitudinal analysis of electronic health records in the health improvement network (THIN), a UK primary care database including 92 186 men and women aged >= 18 years with IHD and a median of 2 (IQR 1-3) comorbidities.ResultsLatent class analysis revealed five clusters with half categorised as a low-burden comorbidity group. After a median follow-up of 3.2 (IQR 1.4-5.8) years, 17 645 patients died. Compared with the low-burden comorbidity group, two groups of patients with a high-burden of comorbidities had the highest adjusted HR for mortality: those with vascular and musculoskeletal conditions, HR 2.38 (95% CI 2.28 to 2.49) and those with respiratory and musculoskeletal conditions, HR 2.62 (95% CI 2.45 to 2.79). Hazards of mortality in two other groups of patients characterised by cardiometabolic and mental health comorbidities were also higher than the low-burden comorbidity group; HR 1.46 (95% CI 1.39 to 1.52) and 1.55 (95% CI 1.46 to 1.64), respectively.ConclusionsThis analysis has identified five distinct comorbidity clusters in patients with IHD that were differentially associated with risk of mortality. These analyses should be replicated in other large datasets, and this may help shape the development of future interventions or health services that take into account the impact of these comorbidity clusters.