Patterns of multimorbidity in internal medicine patients in Swiss university hospitals: a multicentre cohort study.

Carole E Aubert,Drahomir Aujesky,Pedro-Manuel Vasques-Vidal,Jacques Donz,Jrme Stirnemann,Niklaus Fankhauser,Andreas Limacher

doi:10.4414/smw.2019.20094

Carole E Aubert, Drahomir Aujesky + Show 5 more

Open Access

https://doi.org/10.4414/smw.2019.20094

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Abstract

Despite the high prevalence of multimorbidity, we lack detailed descriptive data on the most prevalent combinations of chronic comorbidities in Switzerland. We aimed to describe and quantify the most prevalent combinations of comorbidities in internal medicine multimorbid inpatients. We conducted a multicentre retrospective cohort study including all consecutive adults (n = 42,739) discharged from the general internal medicine department of three Swiss tertiary teaching hospitals in 2010–2011. We used the Chronic Condition Indicator and the Clinical Classification Software to classify International Classification of Diseases diagnosis codes into chronic or acute diseases, into body system categories and into categories of chronic comorbidities. We defined multimorbidity as ≥2 chronic diseases. We described the most prevalent combinations of comorbidities and their prevalence. Seventy-nine percent (n = 33,871) of the patients were multimorbid, with a median of four chronic diseases. Chronic heart disease, chronic kidney disease, solid malignancy and substance-related disorders were the most prevalent comorbidities, with a prevalence of more than 10% for each. All these comorbidities were frequently found in combination with chronic obstructive pulmonary disease and bronchiectasis, pulmonary heart disease, and peripheral and visceral atherosclerosis. Chronic heart disease was identified in 80% of the most prevalent combinations. Half of the combinations occurred more often than it would have been expected if they were independent. The vast majority of patients fulfilled the criteria for multimorbidity. Chronic heart disease, chronic kidney disease, solid malignancy and substance-related disorders were each present in at least one tenth of the patients. This in-depth description of the most frequent comorbidities and of their frequent associations in a multicentre population may advise healthcare providers to improve preventive care and develop appropriate guidelines for multimorbid patients. &nbsp.

Highlights

With the progress of medical science and increasing life expectancy, multimorbidity, most often defined as the presence of at least two chronic diseases [1], is affecting a growing proportion of patients and its prevalence is expected to further increase in the coming years [2,3,4,5,6]
Chronic kidney disease, solid malignancy and substance-related disorders were the most prevalent comorbidities, with a prevalence of more than 10% for each
Chronic heart disease was identified in 80% of the most prevalent combinations

Summary

Introduction

With the progress of medical science and increasing life expectancy, multimorbidity, most often defined as the presence of at least two chronic diseases [1], is affecting a growing proportion of patients and its prevalence is expected to further increase in the coming years [2,3,4,5,6]. Most studies were conducted in ambulatory care settings, did not use standardised tools to classify the diseases, and included diseases, and risk factors or symptoms in the analyses [13,14,15,16,17,18,19,20,21,22,23, 25]. Doing so, they often revealed expected associations, such as cardiovascular diseases and risk factors. In Switzerland, a recent study described patterns of multimorbidity in patients cared for in general practitioner practices [9], while data for hospitalised patients are lacking

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