(218) Prevalence of Comorbidities and Multimorbidity Among Patients with Atherosclerotic Cardiovascular Disease: A Retrospective Observational Study in a Large US Commercially Insured and Medicare Advantage Population
Principal Investigator and Lead Data Scientist CVS Health Clinical Trial Services LLC Woonsocket, United States
Background: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality and disability in the United States. Multimorbidity increases the complexity of disease management and poses significant clinical and public health challenges. Real-world evidence on multimorbidity in ASCVD is lacking.
Objectives: To assess the prevalence and patterns of common comorbidities and multimorbidity among patients with ASCVD.
Methods: This is a retrospective observational cohort study using the Aetna administrative claims database. Patients with ASCVD were identified during the study period (1/1/2018-10/31/2021). The earliest ASCVD diagnosis date was identified as index date. Qualified patients were ≥18 years of age and had ≥12 months of health plan enrollment before and after the index date. Patient socioeconomic and demographic characteristics and comorbid conditions were assessed using all data available within 12 months prior to and including the index date (baseline period). Lipid lowering therapy (LLT) was assessed using all data within 12 months after the index date (follow-up period). Patient characteristics, LLT use, comorbidities, and multimorbidity were summarized via descriptive statistical analyses, overall and by subgroups of age ( < 65, ≥65 years), gender (female, male), and LLT use (without, with).
Results: Of 223,923 patients with ASCVD, mean [SD] baseline age was 73.59 [10.73], 42.23% were female, 78.03% had LLT during the follow-up period. 99.7% of patients had ≥1 comorbid conditions, 98.5% had ≥2, and 89.1% had ≥5. The mean [SD] number of comorbid conditions was 8.47 [3.41], median [IQR] was 8 [6-11]. The most common comorbid conditions were hypertension (88.84%), dyslipidemia (86.13%), pain disorders (76.26%), diabetes mellitus (41.92%), and obesity (37.97%). The comorbidity burden tended to increase in older age groups and was higher in females than males and higher in patients with LLT than without LLT.
Conclusions: Multimorbidity was highly prevalent among patients with ASCVD. Comorbidity and multimorbidity patterns varied considerably across ASCVD patients and by age, gender, and LLT use status. The presence of comorbidity and multimorbidity should be considered in the context of clinical and policy decision making to optimize cardiovascular care and improve health outcomes.
