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

Muhammad Rashid, Chun Shing Kwok, Chris P Gale, Patrick Joseph Doherty, Ivan Olier, Matthew Sperrin, Evangelos Kontopantelis, George Peat, Mamas A Mamas

Research output: Contribution to journalArticlepeer-review


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.
Original languageEnglish
Pages (from-to)20-36
Number of pages17
JournalEuropean Heart Journal — Quality of Care & Clinical Outcomes
Issue number1
Early online date10 May 2016
Publication statusPublished - 16 Jun 2016

Bibliographical note

© 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


  • Cardiovascular disease
  • Charlson Co-morbidity Index
  • Mortality

Cite this