Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care

Abstract

Self-efficacy is important in the self-care maintenance process at each level of comorbidity. Because higher comorbidity weakens the strength of the relationship between self-efficacy and self-care maintenance, tailoring interventions aimed at improving self-efficacy to different levels of comorbidity may be key to impacting hospitalization and quality of life.

Magnitude and Impact of Multimorbidity on Clinical Outcomes in Older Adults with Cardiovascular Disease

“…Five studies included patients with acute myocardial infarction, and 10 included patients with heart failure as the cardiovascular condition of interest. Six of the included studies were retrospective cohort studies, 3,9,10,12,14 four were cross-sectional, 5,15,16,17 three were prospective cohort studies, 18,19,20 and two were randomized controlled trials. 21,22 Seven were US-based studies; 3,5,9,10,14,16,20 non-US-based studies (n= 8) were performed in Canada 13,22 and several European countries , including Italy, 17 Spain, 15 Portugal, 12 Denmark, 21 France, 18 and the Netherlands.…”

“…Six of the included studies were retrospective cohort studies, 3,9,10,12,14 four were cross-sectional, 5,15,16,17 three were prospective cohort studies, 18,19,20 and two were randomized controlled trials. 21,22 Seven were US-based studies; 3,5,9,10,14,16,20 non-US-based studies (n= 8) were performed in Canada 13,22 and several European countries , including Italy, 17 Spain, 15 Portugal, 12 Denmark, 21 France, 18 and the Netherlands. 19 Eleven studies utilized medical records for data collection, 3,5,9,10,12,13,15,18,19,20,21 three employed claims-based data, 14,16,17 and one group of authors analyzed data on multimorbidity collected in the context enrolling subjects in a large randomized controlled trial (SOLVD).…”

“…The number of chronic conditions was assessed by simple counts of chronic conditions 3,5,9,10,12,14,16,18,20,21,22 (n=11), by combination of the Elixhauser and Charlson indices 15 (n=1), and by the Charlson index alone 13, 17, 19 (n=3) (Table 2). The prevalence of chronic conditions ranged from at least one additional morbidity in 10% 5 to 77% 9 of persons; the frequency of four or more additional chronic conditions ranged from 5% 9 to 60%.…”

“…Of note, we identified only one study that reported on outcomes falling in to the category of “universal outcomes.” 17 In a cohort of 628 patients with heart failure, the investigators found a statistically significant association between the overall burden of comorbidity, as assessed by the Charlson comorbidity index, and worse physical and emotional quality of life (Pearson’s correlation coefficients were reported for this analysis; for example, for emotional quality of life, the coefficient decreased from 0.16 in those with one to 0.04 in those with four chronic conditions based on the Charlson index.) 17 …”

“…3,5,10,12,13,14,15,16,17,18,19,20,21,22 Although a number of different approaches exist for measuring multimorbidity, none of these is considered to be a “gold standard.” Simply counting morbidities is seemingly straightforward; however, this approach does not take into account the clinical severity of a condition or the varying impact across conditions. Comorbidity indices are relatively easy to apply, but may also lack sufficient specificity to adequately characterize the complexity of patients presenting with multimorbidity and CVD.…”