Mamas Mamas m.mamas@keele.ac.uk
Impact of Co-morbid burden on mortality in patients with coronary heart disease, heart failure and cerebrovascular accident: a systematic review and meta-analysis
Mamas; Rashid
Abstract
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.
Acceptance Date | May 2, 2016 |
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Publication Date | Jan 1, 2017 |
Publicly Available Date | Mar 28, 2024 |
Journal | European Heart Journal - Quality of Care and Clinical Outcomes |
Print ISSN | 2058-5225 |
Publisher | Oxford University Press |
Pages | 20-36 |
DOI | https://doi.org/10.1093/ehjqcco/qcw025 |
Keywords | Charlson comobidity index, cardiovascular disease, mortality |
Publisher URL | http://dx.doi.org/10.1093/ehjqcco/qcw025 |
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https://creativecommons.org/licenses/by-nc/4.0/
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