Sex differences in multimorbidity among patients with heart failure: a population-based cohort study
A Fuller, D Edwards, S Chaman, N C Okwose, F Bano, B Flis, P Vracar, Z Bosnic, M Dobric, M Bojic, G A Macgowan, P Banerjee, P M Seferovic, J Mant, D JakovljevicAbstract
Background and Aim
There is limited comprehensive population-based evidence describing the prevalence and burden of multimorbidity among individuals with heart failure (HF). This study assessed the prevalence and distribution of multimorbidity among adult men and women living with HF.
Methods
A population-based, cross-sectional study using electronic health records from the UK Clinical Practice Research Datalink (CPRD) database was conducted to explore multimorbidity. Adults aged ≥45 years with a recorded diagnosis of HF prior to 1 January 2024, who were alive on that date and had at least two years of continuous medical records, were included. Multimorbidity was defined as the presence of two or more long-term conditions recorded at any time during the study period (1 January 2004 to 1 January 2024).
Results
A total of 149827 (male: 87,781 and female: 62,046) HF patient records were assessed. The most prevalent comorbidities (male and female) were hypertension (63% and 70%); chronic kidney disease (35% vs 46%); diabetes mellitus (35% and 30%); anaemia (37% and 18%); and chronic obstructive pulmonary disease (27% and 29%). Prior myocardial infarction was 14% more common in males than females (32% vs 18%). Multimorbidity was highly prevalent in HF, with 93% of patients having an additional two, 78% three, and 55% four comorbidities.
Conclusion
Multimorbidity is common among adults with HF and substantially increases clinical complexity in routine clinical practice. The high burden of cardiometabolic and non-cardiac conditions in HF underscores the limitations of single-disease management strategies and highlights the need for integrated, multidisciplinary models of HF care. These population-based findings provide clinically and policy-relevant evidence to support coordinated, patient-centred approaches to HF management.