Risk factors, outcomes and healthcare utilisation in individuals with multimorbidity including heart failure, chronic kidney disease and type 2 diabetes mellitus: a national electronic health record study

Abstract

BackgroundHeart failure (HF), type 2 diabetes (T2D) and chronic kidney disease (CKD) commonly coexist. We studied characteristics, prognosis and healthcare utilisation of individuals with two of these conditions.MethodsWe performed a retrospective, population-based linked electronic health records study from 1998 to 2020 in England to identify individuals diagnosed with two of: HF, T2D or CKD. We described cohort characteristics at time of second diagnosis and estimated risk of developing the third condition and mortality using Kaplan-Meier and Cox regression models. We also estimated rates of healthcare utilisation in primary care and hospital settings in follow-up.FindingsWe identified cohorts of 64 226 with CKD and HF, 82 431 with CKD and T2D, and 13 872 with HF and T2D. Compared with CKD and T2D, those with CKD and HF and HF and T2D had more severe risk factor profile. At 5 years, incidence of the third condition and all-cause mortality occurred in 37% (95% CI: 35.9%, 38.1%%) and 31.3% (30.4%, 32.3%) in HF+T2D, 8.7% (8.4%, 9.0%) and 51.6% (51.1%, 52.1%) in HF+CKD, and 6.8% (6.6%, 7.0%) and 17.9% (17.6%, 18.2%) in CKD+T2D, respectively. In each of the three multimorbid groups, the order of the first two diagnoses was also associated with prognosis. In multivariable analyses, we identified risk factors for developing the third condition and mortality, such as age, sex, medical history and the order of disease diagnosis. Inpatient and outpatient healthcare utilisation rates were highest in CKD and HF, and lowest in CKD and T2D.InterpretationHF, CKD and T2D carry significant mortality and healthcare burden in combination. Compared with other disease pairs, individuals with CKD and HF had the most severe risk factor profile, prognosis and healthcare utilisation. Service planning, policy and prevention must take into account and monitor data across conditions.

Identifying subtypes of type 2 diabetes mellitus with machine learning: development, internal validation, prognostic validation and medication burden in linked electronic health records in 420 448 individuals

“…20 21 25 However, as lifetime risk and multiple long-term conditions are increasingly investigated, the similarity of subtypes across T2D is associated with high morbidity, mortality and healthcare utilization and costs, particularly in the context of multiple long-term conditions. 29 We confirm the high burden of disease and high hospitalization rates, consistent with previous studies. There are clear differences in prognosis across the four subtypes, whether by all-cause mortality, hospital admissions or new diseases.…”

Impact of multimorbidity patterns on outcomes and treatment in patients with coronary artery disease

“… 32 Chronic kidney disease further exacerbates mortality, bleeding, and complications through uraemic toxicity, electrolyte abnormalities, and drug clearance issues. 33 , 34 Diabetes interacts deleteriously through macro- and microvascular damage, glucose variability, and polypharmacy. 33 , 35 Therefore, the patterns likely reflect shared risk factors, cumulative damage, and pathophysiologic interactions between conditions.…”

“… 33 , 34 Diabetes interacts deleteriously through macro- and microvascular damage, glucose variability, and polypharmacy. 33 , 35 Therefore, the patterns likely reflect shared risk factors, cumulative damage, and pathophysiologic interactions between conditions.…”

A Retrospective Multi-site Examination of Chronic Kidney Disease Using Longitudinal Laboratory Results and Metadata to Identify Clinical and Financial Risk

“…The incidence of CKD is on the rise due to the increase in prevalence of risk factors including diabetes, heart disease and an aging population (3). Conversely, CKD is a strong risk factor for adverse outcomes of cardiovascular disease (4,5), including markedly increased costs for hospitalization (6). Furthermore, the economic impact is substantial with the cost of treating Medicare beneficiaries with CKD totaling $87.2 billion annually.…”