Influence of multimorbidity and socioeconomic position on long-term healthcare utilization and prognosis in patients after cardiac resynchronization therapy implantation

Christoffer Tobias Witt; Rikke Elmose Mols; István Bakos; Erzsébet Horváth-Puhó; Bo Christensen; Brian Bridal Løgstrup; Jens Cosedis Nielsen; Hans Eiskjær

doi:10.1093/ehjopen/oeae029

Influence of multimorbidity and socioeconomic position on long-term healthcare utilization and prognosis in patients after cardiac resynchronization therapy implantation

Christoffer Tobias Witt^*, Rikke Elmose Mols, István Bakos, Erzsébet Horváth-Puhó, Bo Christensen, Brian Bridal Løgstrup, Jens Cosedis Nielsen, Hans Eiskjær

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Aims We aimed to investigate the influence of socioeconomic position (SEP) and multimorbidity on cross-sectional healthcare utilization and prognosis in patients after cardiac resynchronization therapy (CRT) implantation. Methods We included first-time CRT recipients with left ventricular ejection fraction ≤35% implanted between 2000 and 2017. Data and results on chronic conditions, use of healthcare services, and demographics were obtained from Danish national administrative and health registries. Healthcare utilization (in- and outpatient hospitalizations, activities in general practice) was compared by multimorbidity categories and SEP by using a negative binomial regression model. The association between SEP, multimorbidity, and prognostic outcomes was analysed using Cox proportional hazards regression. We followed 2007 patients (median age of 70 years), 79% were male, 75% were on early retirement or state pension, 37% were living alone, and 41% had low education level for a median of 5.2 [inter-quartile range: 2.2–7.3) years. In adjusted regression models, a higher number of chronic conditions were associated with increased healthcare utilization. Both cardiovascular and non-cardiovascular hospital contacts were increased. Patients with low SEP had a higher number of chronic conditions, but SEP had limited influence on healthcare utilization. Patients living alone and those with low educational level had a trend towards a higher risk of all-cause mortality [adjusted hazard ratio (aHR): 1.17, 95% confidence interval (CI) 1.03–1.33, and aHR 1.09, 95% CI 0.96–1.24). Conclusion Multimorbidity increased the use of cross-sectional healthcare services, whereas low SEP had minor influence on the utilizations. Living alone and low educational level showed a trend towards a higher risk of mortality after CRT implantation.

Original language	English
Article number	oeae029
Journal	European Heart Journal Open
Volume	4
Issue	3
ISSN	2752-4191
DOIs	https://doi.org/10.1093/ehjopen/oeae029
Publication status	Published - 1 May 2024

Keywords

Cardiac resynchronization therapy
Healthcare utilization
Heart failure
Multimorbidity
Prognosis
Socioeconomic position

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10.1093/ehjopen/oeae029Licence: CC BY-NC

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Witt, C. T., Mols, R. E., Bakos, I., Horváth-Puhó, E., Christensen, B., Løgstrup, B. B., Nielsen, J. C., & Eiskjær, H. (2024). Influence of multimorbidity and socioeconomic position on long-term healthcare utilization and prognosis in patients after cardiac resynchronization therapy implantation. European Heart Journal Open, 4(3), Article oeae029. https://doi.org/10.1093/ehjopen/oeae029

@article{cf3d60e9e7d24348af80a57bf11f62f1,

title = "Influence of multimorbidity and socioeconomic position on long-term healthcare utilization and prognosis in patients after cardiac resynchronization therapy implantation",

abstract = "Aims We aimed to investigate the influence of socioeconomic position (SEP) and multimorbidity on cross-sectional healthcare utilization and prognosis in patients after cardiac resynchronization therapy (CRT) implantation. Methods We included first-time CRT recipients with left ventricular ejection fraction ≤35% implanted between 2000 and 2017. Data and results on chronic conditions, use of healthcare services, and demographics were obtained from Danish national administrative and health registries. Healthcare utilization (in- and outpatient hospitalizations, activities in general practice) was compared by multimorbidity categories and SEP by using a negative binomial regression model. The association between SEP, multimorbidity, and prognostic outcomes was analysed using Cox proportional hazards regression. We followed 2007 patients (median age of 70 years), 79% were male, 75% were on early retirement or state pension, 37% were living alone, and 41% had low education level for a median of 5.2 [inter-quartile range: 2.2–7.3) years. In adjusted regression models, a higher number of chronic conditions were associated with increased healthcare utilization. Both cardiovascular and non-cardiovascular hospital contacts were increased. Patients with low SEP had a higher number of chronic conditions, but SEP had limited influence on healthcare utilization. Patients living alone and those with low educational level had a trend towards a higher risk of all-cause mortality [adjusted hazard ratio (aHR): 1.17, 95% confidence interval (CI) 1.03–1.33, and aHR 1.09, 95% CI 0.96–1.24). Conclusion Multimorbidity increased the use of cross-sectional healthcare services, whereas low SEP had minor influence on the utilizations. Living alone and low educational level showed a trend towards a higher risk of mortality after CRT implantation.",

keywords = "Cardiac resynchronization therapy, Healthcare utilization, Heart failure, Multimorbidity, Prognosis, Socioeconomic position",

author = "Witt, {Christoffer Tobias} and Mols, {Rikke Elmose} and Istv{\'a}n Bakos and Erzs{\'e}bet Horv{\'a}th-Puh{\'o} and Bo Christensen and L{\o}gstrup, {Brian Bridal} and Nielsen, {Jens Cosedis} and Hans Eiskj{\ae}r",

year = "2024",

month = may,

day = "1",

doi = "10.1093/ehjopen/oeae029",

language = "English",

volume = "4",

journal = "European Heart Journal Open",

issn = "2752-4191",

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number = "3",

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Witt, CT , Mols, RE , Bakos, I , Horváth-Puhó, E , Christensen, B , Løgstrup, BB , Nielsen, JC & Eiskjær, H 2024, 'Influence of multimorbidity and socioeconomic position on long-term healthcare utilization and prognosis in patients after cardiac resynchronization therapy implantation', European Heart Journal Open, vol. 4, no. 3, oeae029. https://doi.org/10.1093/ehjopen/oeae029

Influence of multimorbidity and socioeconomic position on long-term healthcare utilization and prognosis in patients after cardiac resynchronization therapy implantation. / Witt, Christoffer Tobias ; Mols, Rikke Elmose ; Bakos, István et al.
In: European Heart Journal Open, Vol. 4, No. 3, oeae029, 01.05.2024.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Influence of multimorbidity and socioeconomic position on long-term healthcare utilization and prognosis in patients after cardiac resynchronization therapy implantation

AU - Witt, Christoffer Tobias

AU - Mols, Rikke Elmose

AU - Bakos, István

AU - Horváth-Puhó, Erzsébet

AU - Christensen, Bo

AU - Løgstrup, Brian Bridal

AU - Nielsen, Jens Cosedis

AU - Eiskjær, Hans

PY - 2024/5/1

Y1 - 2024/5/1

N2 - Aims We aimed to investigate the influence of socioeconomic position (SEP) and multimorbidity on cross-sectional healthcare utilization and prognosis in patients after cardiac resynchronization therapy (CRT) implantation. Methods We included first-time CRT recipients with left ventricular ejection fraction ≤35% implanted between 2000 and 2017. Data and results on chronic conditions, use of healthcare services, and demographics were obtained from Danish national administrative and health registries. Healthcare utilization (in- and outpatient hospitalizations, activities in general practice) was compared by multimorbidity categories and SEP by using a negative binomial regression model. The association between SEP, multimorbidity, and prognostic outcomes was analysed using Cox proportional hazards regression. We followed 2007 patients (median age of 70 years), 79% were male, 75% were on early retirement or state pension, 37% were living alone, and 41% had low education level for a median of 5.2 [inter-quartile range: 2.2–7.3) years. In adjusted regression models, a higher number of chronic conditions were associated with increased healthcare utilization. Both cardiovascular and non-cardiovascular hospital contacts were increased. Patients with low SEP had a higher number of chronic conditions, but SEP had limited influence on healthcare utilization. Patients living alone and those with low educational level had a trend towards a higher risk of all-cause mortality [adjusted hazard ratio (aHR): 1.17, 95% confidence interval (CI) 1.03–1.33, and aHR 1.09, 95% CI 0.96–1.24). Conclusion Multimorbidity increased the use of cross-sectional healthcare services, whereas low SEP had minor influence on the utilizations. Living alone and low educational level showed a trend towards a higher risk of mortality after CRT implantation.

AB - Aims We aimed to investigate the influence of socioeconomic position (SEP) and multimorbidity on cross-sectional healthcare utilization and prognosis in patients after cardiac resynchronization therapy (CRT) implantation. Methods We included first-time CRT recipients with left ventricular ejection fraction ≤35% implanted between 2000 and 2017. Data and results on chronic conditions, use of healthcare services, and demographics were obtained from Danish national administrative and health registries. Healthcare utilization (in- and outpatient hospitalizations, activities in general practice) was compared by multimorbidity categories and SEP by using a negative binomial regression model. The association between SEP, multimorbidity, and prognostic outcomes was analysed using Cox proportional hazards regression. We followed 2007 patients (median age of 70 years), 79% were male, 75% were on early retirement or state pension, 37% were living alone, and 41% had low education level for a median of 5.2 [inter-quartile range: 2.2–7.3) years. In adjusted regression models, a higher number of chronic conditions were associated with increased healthcare utilization. Both cardiovascular and non-cardiovascular hospital contacts were increased. Patients with low SEP had a higher number of chronic conditions, but SEP had limited influence on healthcare utilization. Patients living alone and those with low educational level had a trend towards a higher risk of all-cause mortality [adjusted hazard ratio (aHR): 1.17, 95% confidence interval (CI) 1.03–1.33, and aHR 1.09, 95% CI 0.96–1.24). Conclusion Multimorbidity increased the use of cross-sectional healthcare services, whereas low SEP had minor influence on the utilizations. Living alone and low educational level showed a trend towards a higher risk of mortality after CRT implantation.

KW - Cardiac resynchronization therapy

KW - Healthcare utilization

KW - Heart failure

KW - Multimorbidity

KW - Prognosis

KW - Socioeconomic position

UR - http://www.scopus.com/inward/record.url?scp=85195179777&partnerID=8YFLogxK

U2 - 10.1093/ehjopen/oeae029

DO - 10.1093/ehjopen/oeae029

M3 - Journal article

C2 - 38828270

SN - 2752-4191

VL - 4

JO - European Heart Journal Open

JF - European Heart Journal Open

IS - 3

M1 - oeae029

ER -

Influence of multimorbidity and socioeconomic position on long-term healthcare utilization and prognosis in patients after cardiac resynchronization therapy implantation

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Keywords

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