Abstract
Background: Both non-cardiac and cardiac comorbidities are related to the prognosis of chronic heart failure (HF), but so far little is known about the impact of comorbidities on treatment diffculties in routine care. Objectives: To investigate which comorbidities are associated with treatment diffculties in primary care. We hypothesized that somatic comorbidities as well as psychosocial distress are associated with treatment diffculties. Methods: In this baseline analysis of data of the observational RECODE-HF study, HF patients were recruited via primary care practices in two German sites. They received a questionnaire by mail to measure psychosocial distress. Each patient's GP was interviewed by phone regarding the patient's comorbidities and treatment diffculties. Logistic regression analyses controlled for GP cluster effects were calculated to investigate the association between comorbidities/psychosocial distress and treatment diffculties. Results: The 3282 patients of 285 GPs included in the analysis were aged 74.2 (±10.1) years and had a mean number of 4.6 (±2.4) comorbidities. GPs reported treatment diffculties in 32.5% of the patients. Allergies/drug intolerance [odds ratio (ORs)=2.0], asthma/chronic obstructive pulmonary disease (ORs=1.4), renal insuffciency (ORs=1.3), atherosclerosis/peripheral arterial occlusive disease (ORs=1.3) and cardiac arrhythmias (ORs=1.2) as well as patient-reported psychosocial distress (ORs=1.2), HF severity (ORs=3.7-1.6) and age (ORs=0.98) were associated with treatment diffculties. Conclusion: Five somatic comorbidity groups as well as patient-reported psychosocial distress were signifcantly associated with a higher risk of GP-reported treatment diffculties. Further efforts to address comorbidities in clinical guidelines could be built on these results.
| Original language | English |
|---|---|
| Journal | Family Practice |
| Volume | 35 |
| Issue number | 4 |
| Pages (from-to) | 481-487 |
| Number of pages | 7 |
| ISSN | 0263-2136 |
| DOIs | |
| Publication status | Published - 2018 |
Funding
Funding: The study has been funded by the German Federal Ministry of Education and Research (grant numbers 01GY1150 and 01EO1004). Ethical approval: The study was approved by all local ethics committees (Medical Association of Hamburg, Approval No. PV3889; Ethics Committee of the Medical Faculty of the University of Würzburg, Approval No. 125/12, Ethics Committee at the University of Göttingen Medical Center, Approval No. 19/8/11). All study participants gave written informed consent before participating in the study. Conflict of interest: SB received fees for part-time lecturer/statistical consulting of Asklepios Medical School GmbH. EB is employed at Helsana Health Insurances, Zürich, Switzerland. CH-L receives royalties from Hogrefe Huber publishers for the German HADS version. All other authors declare that they have no competing financial interests. Non-financial competing interests: ME and EB are members of the German College of General Practitioners and Family Physicians. CH-L chairs the working group on Psychosomatics in Cardiology in the German College of Psychosomatic Medicine and is the immediate Past President of the American Psychosomatic Society. MS is vice president of the German College of General
Research Areas and Centers
- Research Area: Center for Population Medicine and Public Health (ZBV)
