Introduction:
The increasing prevalence of multimorbidity (> 2 chronic conditions) is a challenge for healthcare providers and systems. Multimorbidity complicates treatment and increases the risk of adverse outcomes.
Objectives:
To identify multimorbidity classes (clusters of > 2 specific chronic conditions) in a secondary analysis of a multi-site study about symptoms in patients presenting to the emergency department (ED) for potential acute coronary syndrome (ACS).
Hypothesis:
Specific multimorbidity classes can predict an ACS diagnosis.
Methods:
Chronic conditions were measured (Charlson Comorbidity Index and ACS Patient Information Questionnaire) in patients who underwent a cardiac evaluation in the ED. Latent class analysis was used to identify multimorbidity classes, and logistic regression determined whether multimorbidity classes were predictive of being ruled-in versus ruled-out for ACS.
Results:
The sample (
n
= 935) was 38% female, with a mean age of 59 years. Four multimorbidity classes were identified and labeled: High multimorbidity (Class 1, hyperlipidemia, hypertension [HTN], obesity, diabetes, and respiratory disorders); Low multimorbidity (Class 2, obesity); Cardiovascular multimorbidity (Class 3, HTN, hyperlipidemia, and coronary heart disease); and Cardio-oncology multimorbidity (Class 4, HTN, hyperlipidemia, and cancer). Patients in Classes 3 and 4 had a 2.8-fold and 1.7-fold increased risk of ruling-in for ACS compared to those in Class 2 who were half as likely to rule-in for ACS (OR 0.45 95% CI 0.33 to 0.61 p=0.001). Class membership differed by sex, age, and family history. Females were more likely to be in Class 1 (44.2%), younger patients in Class 2 (mean age 43.4 ± 9.8 years), older patients in class 4 (mean age 80.0 ± 6.3 years), and those with a family history of sudden cardiac death (< age 55) in Class 3 (58.3%).
Conclusion:
Multimorbidity classes differed according to demographic and clinical variables. Membership in Classes 3 and 4 were predictive of an ACS diagnosis. Clustering patients by multimorbidity class may inform risk-stratification during evaluation for ACS.
Prognostic Value of Elevated Copeptin and High-Sensitivity Cardiac Troponin T in Patients with and without Acute Coronary Syndrome: The ConTrACS Study
