Background

Multimorbidity (> 2 conditions) increases the risk of adverse outcomes and challenges health care systems for patients with acute coronary syndrome (ACS). These complications may be partially attributed to ACS clinical care which is driven by single-disease-based practice guidelines; current guidelines do not consider multimorbidity.

Objectives

To identify multimorbidity phenotypes (combinations of conditions) with suspected ACS. We hypothesized that: 1) subgroups of patients with similar multimorbidity phenotypes could be identified, 2) classes would differ according to diagnosis, and 3) class membership would differ by sex, age, functional status, family history, and discharge diagnosis.

Methods

This was a secondary analysis of data from a large multi-site clinical study of patients with suspected ACS. Conditions were determined by items on the Charlson Comorbidity Index and the ACS Patient Information Questionnaire. Latent class analysis was used to identify phenotypes.

Results

The sample (n = 935) was predominantly male (68%) and middle-aged (mean= 59 years). Four multimorbidity phenotypes were identified: 1) high multimorbidity (Class 1) included hyperlipidemia, hypertension (HTN), obesity, diabetes, and respiratory disorders (COPD or asthma); 2) low multimorbidity (Class 2) included only obesity; 3) cardiovascular multimorbidity (Class 3) included HTN, hyperlipidemia, and coronary heart disease; and 4) cardio-oncology multimorbidity (Class 4) included HTN, hyperlipidemia, and cancer. Patients ruled-in for ACS primarily clustered in Classes 3 and 4 (OR 2.82, 95% CI 1.95–4.05, p = 0.001 and OR 1.76, 95% CI 1.13–2.74, p = 0.01).

Conclusion

Identifying and understanding multimorbidity phenotypes may assist with risk-stratification and better triage of high-risk patients in the emergency department.

中文翻译：

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急诊科就诊的可能急性冠状动脉综合征患者的多发病表型

背景

多种疾病（> 2 种情况）增加了急性冠状动脉综合征 (ACS) 患者出现不良结果的风险并挑战医疗保健系统。这些并发症可能部分归因于由基于单一疾病的实践指南驱动的 ACS 临床护理；目前的指南不考虑多发病。

目标

识别疑似 ACS 的多发病表型（条件组合）。我们假设：1）可以识别具有相似多发病表型的患者亚组，2）分类会因诊断而异，3）分类会因性别、年龄、功能状态、家族史和出院诊断而异。

方法

这是对疑似 ACS 患者的大型多中心临床研究数据的二次分析。条件由查尔森合并症指数和 ACS 患者信息问卷中的项目确定。潜在类别分析用于鉴定表型。

结果

样本 ( n  = 935) 主要是男性 (68%) 和中年人 (平均 = 59 岁)。确定了四种多发病表型：1）高多发病（1 类）包括高脂血症、高血压（HTN）、肥胖、糖尿病和呼吸系统疾病（COPD 或哮喘）；2) 低多重发病率（2 类）仅包括肥胖；3）心血管多发病（3级）包括高血压、高脂血症和冠心病；4) 心脏肿瘤多发病（4 类）包括高血压、高脂血症和癌症。确诊 ACS 的患者主要集中在 3 级和 4 级（OR 2.82, 95% CI 1.95–4.05, p  = 0.001 和 OR 1.76, 95% CI 1.13–2.74, p  = 0.01）。

结论

识别和了解多发病表型可能有助于对急诊科的高危患者进行风险分层和更好的分类。