Examining the Presence of Multimorbidity Clusters in Patients Evaluated for Acute Coronary Syndrome

Abstract Objective: 1) to describe the prevalence of multimorbidity in the ACS population and 2) identify multiple, patient-based factors associated with healthcare utilization post evaluation for ACS in the ED. The sample includes patients presenting to the ED with symptoms that triggered an evaluation for possible ACS. Background: Acute coronary syndrome (ACS) is associated with multiple debilitating symptoms, impaired functional status, repeat visits to the emergency department (ED), and frequent healthcare utilization, but inadequate attention has been paid to the relationship between multimorbidity phenotypes (specific combinations of >2 chronic conditions) and healthcare utilization discharge from the hospital. Methods: The first manuscript is a systematic review and the second manuscript is a secondary analysis of data collected from a large multi-site clinical study aimed at characterizing sex differences in symptoms suggestive of ACS. The presence of chronic conditions was obtained from items on the Charlson Comorbidity Index and the ACS Patient Information Questionnaire. Latent class analysis was used to identify multimorbidity classes. Results: Multimorbidity is highly prevalent in the ACS population ranging from 25-95%. Cardiovascular multimorbidity is more prevalent than non-cardiovascular. The sample of 935 was 38% female with a mean age of 59 years. Four multimorbidity classes were identified and labeled high multimorbidity (Class 1), and included hyperlipidemia, hypertension, obesity, diabetes, and respiratory disorders (COPD or asthma); low multimorbidity (Class 2), and only included obesity; cardiovascular multimorbidity (Class 3), and included hypertension, hyperlipidemia, and coronary heart disease; and cardio-oncology multimorbidity (Class 4) which included hypertension, hyperlipidemia, and cancer. Patients in Class 3 experienced an ACS event 100% of the time, while only 1.2% of Class 2 were diagnosed with ACS.