Abstract
BackgroundTo examine age-specific differences in the frequency and impact of cardiac and non-cardiac conditions among patients aged 65 years and older hospitalized with acute myocardial infarction (AMI). MethodsStudy population consisted of 3863 adults hospitalized with AMI at 11 medical centers in central Massachusetts on a biennial basis between 2001 and 2011. The presence of 11 chronic conditions (five cardiac and six non-cardiac) was based on the review of hospital medical records. ResultsParticipants' median age was 79 years, 49% were men, and had an average of three chronic conditions (average of cardiac conditions: 2.6 and average of non-cardiac conditions: 1.0). Approximately one in every two patients presented with two or more cardiac related conditions whereas one in every three patients presented with two or more non-cardiac related conditions. The most prevalent chronic conditions in our study population were hypertension, diabetes, heart failure, chronic kidney disease, and peripheral vascular disease. Patients across all age groups with a greater number of previously diagnosed cardiac or non-cardiac conditions were at higher risk for developing important clinical complications or dying during hospitalization as compared to those with 0–1 condition. ConclusionsThe prevalence of multimorbidity among older adults hospitalized with AMI is high and associated with worse outcomes that should be considered in the management of this vulnerable population.
Highlights
The prevalence of multiple coexistent chronic conditions (MCCs) in patients with cardiovascular disease has become increasingly common, especially as the U.S and other industrialized populations age
Trained nurses and physicians abstracted information on patient's demographic and clinical characteristics and hospital treatment practices and outcomes through the review of hospital medical records. These characteristics included patient's age, sex, race/ethnicity, hospital length of stay, and 11 previously diagnosed chronic conditions. These 11 chronic conditions were further classified into two groups: five Cardiac related conditions: atrial fibrillation, heart failure, hypertension, peripheral vascular disease, and stroke; and six Non-cardiac related conditions: anemia, asthma/chronic pulmonary disease, chronic kidney disease, dementia/Alzheimer, depression, and diabetes
Patients aged 75–84 years old were more likely to have been diagnosed with a non-ST segment elevation myocardial infarction (NSTEMI) and to have had a previously diagnosed acute myocardial infarction (AMI) as compared with those 65–74 years old (Table 1)
Summary
The prevalence of multiple coexistent chronic conditions (MCCs) in patients with cardiovascular disease has become increasingly common, especially as the U.S and other industrialized populations age. Contemporary data describing the magnitude of MCCs in older adults of different ages hospitalized with AMI, and possible age-specific differences in the effects of cardiac and non-cardiac related conditions on the risk of developing important clinical complications and dying during hospitalization for AMI [10,11,12]. The purpose of this large observational study was to describe the magnitude of cardiac and non-cardiac related multimorbidity, among older adults in three age strata (65–74, 75–84 and 85 years and older) hospitalized at all 11 central Massachusetts medical centers with AMI, and to examine the association between burden of cardiac and noncardiac conditions with the risk of developing various adverse outcomes during admission to the hospital for AMI. Conclusions: The prevalence of multimorbidity among older adults hospitalized with AMI is high and associated with worse outcomes that should be considered in the management of this vulnerable population
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