ArticleOpen heart2023
Risk factors, outcomes and healthcare utilisation in individuals with multimorbidity including heart failure, chronic kidney disease and type 2 diabetes mellitus: a national electronic health record study.
Article in Open heart, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed, 13 citations in OpenAlex.
- Implementation of KDIGO CKD Screening and Its Prognostic Implications in Community-Dwelling Adults Aged 75 Years or Older: A Population-Based Cohort Study.Journal of clinical medicine · 2026Article
- Identifying risk individuals for heart failure diagnosis within two years in the adult population in southern Sweden using gender, age, multimorbidity level, and socioeconomic status.BMC cardiovascular disorders · 2026Article
- Missed opportunities to manage complex comorbidity of heart failure, type 2 diabetes mellitus and chronic kidney disease: a retrospective cohort study.Heart (British Cardiac Society) · 2025Article
- The Underdiagnosis of Chronic Kidney Disease in Patients with a Documented Estimated Glomerular Filtration Rate and/or Urine Albumin-Creatinine Ratio in Germany.Medicina (Kaunas, Lithuania) · 2025Article
- A machine learning tool for identifying newly diagnosed heart failure in individuals with known diabetes in primary care.ESC heart failure · 2025Article
- A retrospective multi-site examination of chronic kidney disease using longitudinal laboratory results and metadata to identify clinical and financial risk.BMC nephrology · 2024Observational
- Identifying subtypes of type 2 diabetes mellitus with machine learning: development, internal validation, prognostic validation and medication burden in linked electronic health records in 420 448 individuals.BMJ open diabetes research & care · 2024Article
- Impact of multimorbidity patterns on outcomes and treatment in patients with coronary artery disease.European heart journal open · 2024Article
- The economic impact of multimorbidity in Italy: evaluation of direct costs and scenario analysis of patients with type 2 diabetes, heart failure, and chronic kidney disease using real-world data.Global & regional health technology assessmentArticle
- Addressing methodological challenges in multiple long-term conditions research: A stakeholder workshop using a nominal group technique method.Journal of multimorbidity and comorbidityArticle
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHeart failure (HF), type 2 diabetes (T2D) and chronic kidney disease (CKD) commonly coexist. We studied characteristics, prognosis and healthcare utilisation of individuals with two of these conditions.
methodsWe performed a retrospective, population-based linked electronic health records study from 1998 to 2020 in England to identify individuals diagnosed with two of: HF, T2D or CKD. We described cohort characteristics at time of second diagnosis and estimated risk of developing the third condition and mortality using Kaplan-Meier and Cox regression models. We also estimated rates of healthcare utilisation in primary care and hospital settings in follow-up.
findingsWe identified cohorts of 64 226 with CKD and HF, 82 431 with CKD and T2D, and 13 872 with HF and T2D. Compared with CKD and T2D, those with CKD and HF and HF and T2D had more severe risk factor profile. At 5 years, incidence of the third condition and all-cause mortality occurred in 37% (95% CI: 35.9%, 38.1%%) and 31.3% (30.4%, 32.3%) in HF+T2D, 8.7% (8.4%, 9.0%) and 51.6% (51.1%, 52.1%) in HF+CKD, and 6.8% (6.6%, 7.0%) and 17.9% (17.6%, 18.2%) in CKD+T2D, respectively. In each of the three multimorbid groups, the order of the first two diagnoses was also associated with prognosis. In multivariable analyses, we identified risk factors for developing the third condition and mortality, such as age, sex, medical history and the order of disease diagnosis. Inpatient and outpatient healthcare utilisation rates were highest in CKD and HF, and lowest in CKD and T2D.
interpretationHF, CKD and T2D carry significant mortality and healthcare burden in combination. Compared with other disease pairs, individuals with CKD and HF had the most severe risk factor profile, prognosis and healthcare utilisation. Service planning, policy and prevention must take into account and monitor data across conditions.
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