Influence of multimorbidity and socioeconomic factors on long-term cross-sectional health care service utilization in heart transplant recipients: A Danish cohort study

Mols, Rikke Elmose; Bakos, Istvan; Christensen, Bo; Horváth‐Puhó, Erzsébet; Løgstrup, Brian Bridal; Eiskjær, Hans

doi:10.1016/j.healun.2022.01.006

Cited by 11 publications

(19 citation statements)

References 45 publications

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“…Remarkably, our results reflect that low educational attainment could be the most influential factor on both mortality and MACE, whereas personal income only influenced MACE. A recent single-center Danish study including 325 first-time heart transplant recipients (79% male and 69% between 41 and 60 years) described a lower median number of redeemed medical prescriptions during 15 years of follow-up in heart-transplant recipients within the lowest income group or if living alone ( 20 ). The association between income and prognosis could thus also be partly driven by an economic gradient in use of the prescribed medical treatment after heart transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Age at index date was categorized as 0-20, 21-40, 41-60, and ≥61 years, due to increasing complexities in early, middle, and long-term management post-surgery ( 20 ); follow-up time was defined as 0–1, >1–10, and >10 years. The number of recipients alive at end of follow-up was calculated.…”

Section: Matrials and Methodsmentioning

confidence: 99%

“…We collected information on clinically relevant comorbidities by ICD codes registered in the DNPR ( 18 ) and PCRR ( 18 ) 10 years prior to the index date: Myocardial infarction, angina pectoris, heart failure, heart valve disease, cardiac arrhythmia, congenital heart disease, cardiomyopathy, cardiac inflammation, aortic disease, peripheral arterial disease, cerebrovascular disease, cardiogenic shock and pulmonary edema, diabetes, hypertension, chronic obstructive pulmonary disease, obesity, and psychiatric disorder ( Supplementary Table S1 ). Based on the definition of multimorbidity in other Danish studies ( 20 , 21 ), we summarized the number of comorbidities 10 years prior to the index date. This Danish algorithm estimates multimorbidity as the co-occurrence of two or more chronic conditions included in the 11 comprehensive chronic disease groups ( Supplementary Table S3 ).…”

Section: Matrials and Methodsmentioning

confidence: 99%

“…Based on the increasing complexity in long-term management after transplantation ( 20 ), we determined the impact of all exposure variables on prognostic outcomes within follow-up intervals: 0–1, >1–10, and >10–20 years. Crude and adjusted hazard ratios (HRs) were computed using Cox Proportional Hazards regression comparing recipients within the dichotomized socioeconomic groups.…”

Section: Matrials and Methodsmentioning

confidence: 99%

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Individual-Level Socioeconomic Position and Long-Term Prognosis in Danish Heart-Transplant Recipients

et al. 2023

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Socioeconomic deprivation can limit access to healthcare. Important gaps persist in the understanding of how individual indicators of socioeconomic disadvantage may affect clinical outcomes after heart transplantation. We sought to examine the impact of individual-level socioeconomic position (SEP) on prognosis of heart-transplant recipients. A population-based study including all Danish first-time heart-transplant recipients (n = 649) was conducted. Data were linked across complete national health registers. Associations were evaluated between SEP and all-cause mortality and first-time major adverse cardiovascular event (MACE) during follow-up periods. The half-time survival was 15.6 years (20-year period). In total, 330 (51%) of recipients experienced a first-time cardiovascular event and the most frequent was graft failure (42%). Both acute myocardial infarction and cardiac arrest occurred in ≤5 of recipients. Low educational level was associated with increased all-cause mortality 10–20 years post-transplant (adjusted hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.19–3.19). During 1–10 years post-transplant, low educational level (adjusted HR 1.66, 95% CI 1.14–2.43) and low income (adjusted HR 1.81, 95% CI 1.02–3.22) were associated with a first-time MACE. In a country with free access to multidisciplinary team management, low levels of education and income were associated with a poorer prognosis after heart transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Matrials and Methodsmentioning

confidence: 99%

Section: Matrials and Methodsmentioning

confidence: 99%

Section: Matrials and Methodsmentioning

confidence: 99%

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Individual-Level Socioeconomic Position and Long-Term Prognosis in Danish Heart-Transplant Recipients

et al. 2023

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“…7,20 However, whereas much scholarly attention has been devoted to studying patterns of healthcare utilisation and care, rather less attention has been paid to patients', relatives' and healthcare professionals' perspectives. 21 Thus, important gaps persist in our understanding of how patients with multimorbidity and advanced HF and hospital-employed healthcare professionals experience today's highly specialised healthcare system, forcing patients to independently navigate healthcare systems and consult various stakeholders across and within various sectors to obtain the care needed. To bridge this gap, qualitative research is needed to explore how patients with advanced HF and multimorbidity and hospital-employed healthcare professionals experience what we understand as cross-sectional healthcare and treatment.…”

Section: Introductionmentioning

confidence: 99%

Experiences with cross-sectional healthcare and treatment in heart failure patients: implications for medical education

et al. 2022

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Objectives: to explore how cross-sectional healthcare and treatment is experienced a) by patients with advanced heart failure and multimorbidity and b) by hospital-employed healthcare professionals. Methods: Individual telephone interviews with 18 patients and close relatives were conducted. Furthermore, a focus group session was conducted with four specialised hospitalemployed healthcare professionals. Purposeful sampling was used and interviews were semi-structured. Data were analysed using qualitative inductive content analysis. Results: Three main themes emerged from the interviews with patients and close relatives. These included: 1) A need for improved coordination to ensure continuity of care; 2) a plea for patient-centred care; and 3) recognition of the need to care for close relatives. Analysis of the interviews with hospital-employed healthcare professionals also produced three themes. These concerned: 1) recognition of the role and needs of close relatives; 2) limited resources for and difficulties in meeting these needs; and 3) agreement on the need for patient-centred care. Furthermore, we learned that perceived challenges are rooted in time constraints and the need for an adequate level of medical knowledge of chronic conditions and complex treatment strategies. Conclusions: This study indicates that cross-sectional healthcare and treatment of patients with advanced heart failure and multimorbidity lacked coordination, was insufficiently patient-centred and did not cater for close relatives' needs. The study identifies patient-centredness and coordination of healthcare services targeting patients and close relatives alike as critical to proper care, medical curriculum development and continued medical training courses.

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Socio‐economic position, multimorbidity, and health care utilization among Danish left ventricular assist device patients

Schjødt,

Mols,

Bakos

et al. 2024

ESC Heart Failure

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AimsIncreasing numbers of patients with advanced heart failure and significant comorbidity and social barriers are considered for left ventricular assist devices (LVADs). We sought to examine health care utilization post‐LVAD implantation, including the influence of individual‐level socio‐economic position and multimorbidity.Methods and resultsWe conducted a Danish nationwide cohort study linking individual‐level data from clinical LVAD databases, the Scandiatransplant Database, and Danish national medical and administrative registries. Socio‐economic position included cohabitation status, educational level, and employment status. Multimorbidity was defined as two or more chronic conditions from at least two chronic disease groups. Health care utilization (hospital activity, general practice activity, and redeemed medical prescriptions) within 2 years post‐discharge after LVAD implantation was evaluated using descriptive statistics at 0.5 year intervals. We identified 119 patients discharged alive with first‐time LVAD implanted between 2006 and 2018. The median age of the patients was 56.1 years, and 88.2% were male. Patients were followed until heart transplantation, LVAD explantation, death, 31 December 2018, or for 2 years. The median follow‐up was 0.8 years. The highest median use of health care services was observed 0–0.5 years post‐LVAD discharge compared with the subsequent follow‐up intervals: 0.5–1, 1–1.5, and 1.5–2 years, respectively. The median (interquartile range) number of hospitalizations was 10 (7–14), bed days 14 (9–28), outpatient visits 8 (5–12), telephone contacts with a general practitioner 4 (2–8), and total redeemed medical prescriptions 26 (19–37) within 0–0.5 years post‐LVAD discharge compared with the median utilization within the consecutive follow‐up periods [e.g. within 0.5–1 year: hospitalizations 5 (3–8), bed days 8 (4–14), outpatient visits 5 (3–8), telephone contacts 2 (0–5), and redeemed medical prescriptions 24 (18–30)]. The median use of health care services was stable from 0.5 years onwards. The median number of hospitalizations and bed days was slightly higher in patients living alone with a low educational level or low employment status within 0–0.5 years post‐LVAD implantation. Finally, the median number of in‐hospital days and redeemed prescriptions was higher among patients with pre‐existing multimorbidity.ConclusionsAmong patients who underwent LVAD implantation, health care utilization was high in the early post‐LVAD discharge phase and was influenced by socio‐economic position. Multimorbidity influenced the number of in‐hospital days and redeemed prescriptions during the 2 year follow‐up.

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Influence of multimorbidity and socioeconomic factors on long-term cross-sectional health care service utilization in heart transplant recipients: A Danish cohort study

Cited by 11 publications

References 45 publications

Individual-Level Socioeconomic Position and Long-Term Prognosis in Danish Heart-Transplant Recipients

Individual-Level Socioeconomic Position and Long-Term Prognosis in Danish Heart-Transplant Recipients

Experiences with cross-sectional healthcare and treatment in heart failure patients: implications for medical education

Socio‐economic position, multimorbidity, and health care utilization among Danish left ventricular assist device patients

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