Our research activities, based on large national healthcare data supported by advanced statistical methodology, have gained widespread media coverage in recent months. Professor Gale hit the national headlines for our collaborative work with the Karolinska Institute in Sweden highlighting important discrepancies in heart attack outcomes for women compared with men. Earlier this year, my publication on multimorbidity formed part of a British Heart Foundation media campaign about heart failure.
Whilst cardiovascular disease remains the leading cause of death around the world, some countries have seen a shift in mortality patterns. In the UK, the number of deaths from dementia has now overtaken deaths from heart disease. The two key reasons for this are that people are generally living longer, as well as the fact that more people are surviving heart disease, in particular heart attacks, due to advances in treatments in recent years. An unfortunate consequence of the increasing number of people surviving their heart attack is that that there is a growing population of people who are predisposed to developing additional chronic conditions.
My work, published in Plos Medicine in March, shows that 59.5% of patients hospitalised with a heart attack have at least one additional chronic condition and a substantial number have multiple conditions (referred to as multimorbidity). Across the 700,000 heart attacks included in the study – patients commonly had heart failure in addition to peripheral vascular disease and hypertension at the time of their heart attack. The average life expectancy of these highly multimorbid patients was reduced by approximately 3 years compared to those who were not multimorbid.
Whilst previous studies have studied single co-morbidities, such as diabetes, in combination with a heart attack – this study is the first to address multiple conditions occurring within patients using a thorough and sophisticated statistical approach (latent class analyses) on a national scale. Despite heart failure, peripheral vascular disease and hypertension commonly occurring together for people who have a heart attack, national treatment guidelines focus only on treating individual diseases rather than treatments which focus on a number of these conditions at once. Now that we know more about which diseases occur together, this work can inform the development of new treatment guidelines targeted specifically to these patient groups so that many more lives can be saved in future.
This research was conducted as part of my Sir Henry Wellcome personal fellowship, and as a recently appointed University Academic Fellow, I plan to develop further research in the area of cardiovascular survivorship and multimorbidity. My goal is to challenge healthcare providers and commissioners to consider whole patients rather than their individual diseases, thereby redefining the management and care for people with cardiovascular disease.
Dr Marlous Hall, University Academic Fellow in Cardiovascular Epidemiology.