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MI outcomes tied to 3 multimorbidity phenotype clusters

Research led by the University of Leeds has identified 3 multimorbidity phenotype clusters that are significantly associated with loss in life expectancy in patients with acute myocardial infarction (AMI).

The study, published in PLOS Medicine this week, included 693,388 patients from the Myocardial Ischaemia National Audit Project (England and Wales) who were admitted with AMI between 1 January 2003 and 30 June 2013.

Almost 60% had at least one of the following long-term health conditions at the time of admission: diabetes, COPD or asthma, heart failure, renal failure, cerebrovascular disease, peripheral vascular disease, or hypertension. The worst outcomes were seen among patients with heart failure (39.5; 95% CI, 39.0-40.0 deaths per 100 person-years), renal failure (38.2; 95% CI, 27.7-26.8 deaths/100 person-years), or cerebrovascular disease (26.6; 95% CI, 25.2-26.4 deaths/100 person-years).

Analysis revealed 3 multimorbidity phenotype clusters:

  • Class 1: A high multimorbidity class, with concomitant heart failure, peripheral vascular disease, and hypertension.
  • Class 2: A medium multimorbidity class, with peripheral vascular disease and hypertension.
  • Class 3: A low multimorbidity class.

Patients in Class 1 were less likely to receive pharmacological therapies compared with Class 2 and 3 patients. Less than 84% of those in class 1 received aspirin compared with 87.3% in Class 2 and 87.2% in Class 3. Rates for β-blockers were 74.0% vs 80.9% and 81.4%. For statins, the rates were 80.6% vs 85.9% and 85.2%.

Over the 8.4-year follow-up period, patients in Class 1 and 2 had a 2.4-fold and 1.5-fold increased risk of death and a loss in life expectancy of 2.89 and 1.52 years, respectively, compared with those in Class 3.

The authors say comorbidities should be a concomitant treatment target to improve cardiovascular outcomes.


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