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Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure

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Abstract

Background

Comorbidity—a condition that co-exists with a primary illness—is common among older persons with heart failure and can complicate the overall management of this population.

Objectives

To determine the relationship between advancing age and the prevalence and patterns of comorbidity among older persons with heart failure.

Design

Retrospective longitudinal cohort study

Participants

A total of 201,130 Medicare beneficiaries with heart failure stratified into three age strata in 2001: 66–75, 76–85, and 86+ years, and followed over 5 years.

Measurements

(1) Prevalence of 19 conditions as identified by the Chronic Conditions Warehouse from Medicare claims data, characterized as concordant (related to heart failure) or discordant (unrelated to heart failure), and (2) overall comorbidity burden, defined as count of conditions.

Results

The median number of comorbidities rose from four (IQR: 2–5) to five (IQR: 4–7) among the young-old, and from 4 (IQR: 3–6) to 6 (IQR: 5–8) among the middle-old and oldest-old between 2001 and 2006. In 2001, the majority of concordant conditions were more prevalent among the youngest than oldest beneficiaries (e.g., diabetes 46.2% vs 26.9%; kidney disease 21.8% vs 18.4%), while the majority of discordant conditions were more prevalent among the oldest-old than youngest-old beneficiaries (e.g., dementia 39.6% vs 9.9%; hip fracture 9.5% vs 1.9%). Discordant conditions increased in prevalence faster among the oldest than youngest beneficiaries (e.g., dementia 13% points versus 9% points).

Conclusion

Among older Medicare beneficiaries with heart failure, there is a higher overall burden of comorbidity and greater prevalence of discordant comorbidity among the oldest old. Comorbidity prevalence increases over time, with discordant comorbidity increasing at the fastest rate among the oldest old. This comorbidity burden highlights the challenge of effectively treating heart failure while simultaneously managing co-existing and unrelated conditions.

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Acknowledgements

Dr. Ahluwalia was supported by a training grant from the National Institute on Aging (T32AG1934) and is currently supported by an Office of Academic Affiliation’s VA Associated Health Postdoctoral Fellowship Program at the VA Greater Los Angeles HSR&D Center of Excellence. Dr. Fried is a recipient of a Midcareer Investigator Award in Patient-Oriented Research from the National Institute on Aging (K24 AG028443). Dr. Chaudhry is the recipient of a Paul Beeson/K23 Career Development Award (K23AG030986) from the National Institute on Aging. Supported by the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine (#2P30AG021342-06 NIH/NIA).

Presented as a poster at the 2010 Society of General Internal Medicine Annual Meeting, April 28–May 1, 2010, Minneapolis, MN.

Conflict of Interest

None disclosed

Author information

Authors and Affiliations

  1. Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. 111-G, Los Angeles, CA, 90064, USA

    Sangeeta C. Ahluwalia PhD, MPH

  2. Department of Medicine, Section of General Internal Medicine, Yale School of Medicine, 333 Cedar St., LMP-1072, New Haven, CT, 06520, USA

    Cary P. Gross MD & Sarwat I. Chaudhry MD

  3. Program on Aging, Yale School of Medicine, New Haven, CT, 06520, USA

    Linda Leo-Summers MPH & Peter H. Van Ness PhD, MPH

  4. Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT, 06520, USA

    Peter H. Van Ness PhD, MPH & Terri R. Fried MD

  5. Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA

    Terri R. Fried MD

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  1. Sangeeta C. Ahluwalia PhD, MPH
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  2. Cary P. Gross MD
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Correspondence to Sangeeta C. Ahluwalia PhD, MPH.

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Ahluwalia, S.C., Gross, C.P., Chaudhry, S.I. et al. Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure. J GEN INTERN MED 26, 1145–1151 (2011). https://doi.org/10.1007/s11606-011-1725-6

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  • DOI: https://doi.org/10.1007/s11606-011-1725-6

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