Impact of Co-morbid burden on mortality in patients with coronary heart disease, heart failure and cerebrovascular accident: A systematic review and meta-analysis

TY - JOUR

T1 - Impact of Co-morbid burden on mortality in patients with coronary heart disease, heart failure and cerebrovascular accident

T2 - A systematic review and meta-analysis

AU - Rashid, Muhammad

AU - Kwok, Chun Shing

AU - Gale, Chris P

AU - Doherty, Patrick Joseph

AU - Olier, Ivan

AU - Sperrin, Matthew

AU - Kontopantelis, Evangelos

AU - Peat, George

AU - Mamas, Mamas A

N1 - © Authors 2016. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details

PY - 2016/6/16

Y1 - 2016/6/16

N2 - Aims: We sought to investigate the prognostic impact of co-morbid burden as defined by the Charlson comorbidity index (CCI) in patients with a range of prevalent cardiovascular diseases. Methods & Results: We searched MEDLINE and EMBASE to identify studies that evaluated the impact of CCI on mortality in patients with cardiovascular disease. A random effects meta-analysis was undertaken to evaluate the impact of CCI on mortality in patients with coronary heart disease (CHD), heart failure (HF) and cerebrovascular accident (CVA). A total of 11 studies of acute coronary syndrome (ACS), 2 stable coronary disease, 5 percutaneous coronary intervention (PCI), 13 HF and 4 CVA met the inclusion criteria. An increase in CCI score per point was significantly associated with a greater risk of mortality in patients with ACS (pooled relative risk ratio (RR) 1.33 95%CI 1.15-1.54), PCI (RR 1.21 95% CI1.12-1.31) stable coronary artery disease (RR 1.38 95%CI 1.29-1.48) and HF (RR1.21 95%CI 1.13-1.29), but not CVA. A CCI score >2 significantly increased the risk of mortality in ACS (RR 2.52 95% CI 1.58-4.04), PCI (3.36 95%CI 2.14-5.29), HF (RR 1.76 95%CI 1.65-1.87) and CVA (RR 3.80 95%CI 1.20-12.01). Conclusion: Increasing co-morbid burden as defined by CCI is associated with a significant increase in risk of mortality in patients with underlying CHD, HF and CVA. CCI provides a simple way of predicting adverse outcomes in patients with CV disease and should be incorporated into decision-making processes when counseling patients.

AB - Aims: We sought to investigate the prognostic impact of co-morbid burden as defined by the Charlson comorbidity index (CCI) in patients with a range of prevalent cardiovascular diseases. Methods & Results: We searched MEDLINE and EMBASE to identify studies that evaluated the impact of CCI on mortality in patients with cardiovascular disease. A random effects meta-analysis was undertaken to evaluate the impact of CCI on mortality in patients with coronary heart disease (CHD), heart failure (HF) and cerebrovascular accident (CVA). A total of 11 studies of acute coronary syndrome (ACS), 2 stable coronary disease, 5 percutaneous coronary intervention (PCI), 13 HF and 4 CVA met the inclusion criteria. An increase in CCI score per point was significantly associated with a greater risk of mortality in patients with ACS (pooled relative risk ratio (RR) 1.33 95%CI 1.15-1.54), PCI (RR 1.21 95% CI1.12-1.31) stable coronary artery disease (RR 1.38 95%CI 1.29-1.48) and HF (RR1.21 95%CI 1.13-1.29), but not CVA. A CCI score >2 significantly increased the risk of mortality in ACS (RR 2.52 95% CI 1.58-4.04), PCI (3.36 95%CI 2.14-5.29), HF (RR 1.76 95%CI 1.65-1.87) and CVA (RR 3.80 95%CI 1.20-12.01). Conclusion: Increasing co-morbid burden as defined by CCI is associated with a significant increase in risk of mortality in patients with underlying CHD, HF and CVA. CCI provides a simple way of predicting adverse outcomes in patients with CV disease and should be incorporated into decision-making processes when counseling patients.

KW - Cardiovascular disease

KW - Charlson Co-morbidity Index

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=85021796664&partnerID=8YFLogxK

U2 - 10.1093/ehjqcco/qcw025

DO - 10.1093/ehjqcco/qcw025

M3 - Article

VL - 3

SP - 20

EP - 36

JO - European Heart Journal — Quality of Care & Clinical Outcomes

JF - European Heart Journal — Quality of Care & Clinical Outcomes

SN - 2058-5225

IS - 1

ER -