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, Mamas; Rashid, Muhammad

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.

Citation

Mamas, M., & Rashid, M. (2017). Impact of Co-morbid burden on mortality in patients with coronary heart disease, heart failure and cerebrovascular accident: a systematic review and meta-analysis. European Heart Journal - Quality of Care and Clinical Outcomes, 20-36. https://doi.org/10.1093/ehjqcco/qcw025

• Acceptance Date: May 2, 2016
• Publication Date: Jan 1, 2017
• 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
• Public URL: https://keele-repository.worktribe.com/output/405977
• Publisher URL: http://dx.doi.org/10.1093/ehjqcco/qcw025