Characterising Multimorbidity in Adults With Heart Failure: A Latent Class Analysis

INTRODUCTION/PURPOSE: Multimorbidity (MM) is highly prevalent in patients with heart failure (HF) and associated with worse outcomes; however, our understanding of the heterogeneity of MM in HF is limited. The purpose of this study was to identify and characterise MM classes among adults with HF. METHODS AND RESULTS: We conducted a retrospective modified cross-sectional analysis of the combined baseline data repository of adults with New York Heart Association Class I-IV HF enrolled at a single healthcare centre. Comorbidities were assessed with the Charlson Comorbidity Index (CCI), and latent class mixture modeling was used to identify MM classes. Descriptive and comparative statistics were used to characterise classes. The sample (n=523) was 73% male, with an average age of 58.3±14.0 years. Nearly 92% of the sample had at least one additional comorbidity with hypertension (59%), atrial fibrillation (48%), sleep apnoea/disordered breathing (41%), diabetes (40%), and myocardial infarction (36%) as the most prevalent comorbidities. We identified four distinct MM classes of comorbidity dominance: neurovascular-renal (4.5%; oldest, living alone, highest CCI), obesity-metabolic (31.7%; second-oldest, married/partnered, most financial instability), atrial fibrillation (31.9%; lowest CCI), and early comorbidity (31.9%; youngest, second-most financial instability) in patients with HF, each with differences in characteristics. CONCLUSIONS: We found multiple classes of MM with varying characteristics that may have implications for HF management. Coupled with geriatric cardiology principles related to MM, these findings highlight the need to explore the occurrence of MM, including its effects on patient outcomes, and to provide appropriate person-centred care.