Comorbidity and polypharmacy in chronic heart failure: a large cross-sectional study in primary care

Bosco Baron Franco, Gary McLean, Frances S. Mair, Veronique L. Roger, Bruce Guthrie, Stewart W. Mercer (Lead / Corresponding author)

    Research output: Contribution to journalArticlepeer-review

    23 Citations (Scopus)
    162 Downloads (Pure)


    Background: Comorbidity is common in heart failure, but previous prevalence estimates have been based on a limited number of conditions using mainly non-primary care data sources.Aim To compare prevalence rates of comorbidity and polypharmacy in those with and without chronic heart failure due to left ventricular systolic dysfunction (LVSD).Design and setting A cross-sectional study of 1.4 million patients in primary care in Scotland.

    Method: Data on the presence of LVSD, 31 other physical, and seven mental health comorbidities, and prescriptions were extracted from a database of 1 424 378 adults. Comorbidity prevalence was compared in patients with and without LVSD, standardised by age, sex, and deprivation. Pharmacology data were also compared between the two groups.

    Results: There were 17 285 patients (1.2%) who had a diagnosis of LVSD. Compared with standardised controls, the LVSD group had greater comorbidity, with the biggest difference found for seven or more conditions (odds ratio [OR] 4.10; 95% confidence interval (CI] = 3.90 to 4.32). Twenty-five physical conditions and six mental health conditions were significantly more prevalent in those with LVSD relative to standardised controls. Polypharmacy was higher in the LVSD group compared with controls, with the biggest difference found for ≥11 repeat prescriptions (OR 4.81; 95% CI = 4.60 to 5.04). However, these differences in polypharmacy were attenuated after controlling for the number of morbidities, indicating that much of the additional prescribing was accounted for by multimorbidity rather than LVSD per se.

    Conclusion: Extreme comorbidity and polypharmacy is significantly more common in patients with chronic heart failure due to LVSD. The efficient management of such complexity requires the integration of general and specialist expertise.

    Original languageEnglish
    Pages (from-to)e314-e320
    Number of pages7
    JournalBritish Journal of General Practice
    Issue number658
    Early online date11 Apr 2017
    Publication statusPublished - May 2017


    • Comorbidity
    • General Practice
    • Heart failure
    • Multimorbidity
    • Polypharmacy

    ASJC Scopus subject areas

    • Family Practice


    Dive into the research topics of 'Comorbidity and polypharmacy in chronic heart failure: a large cross-sectional study in primary care'. Together they form a unique fingerprint.

    Cite this