Influence of multimorbidity and socioeconomic position on long-term health care utilization and prognosis in patients after cardiac resynchronization therapy implantation

Abstract

We aimed to investigate the influence of socioeconomic position (SEP) and multimorbidity on cross-sectional health care utilization and prognosis in patients after cardiac resynchronization therapy (CRT) implantation. We included first-time CRT recipients with left ventricular ejection fraction ≤35% implanted between 2000-2017. Data on chronic conditions, use of health care services and demographics were obtained from Danish national administrative and health registries. Health care utilization (in- and outpatient hospitalizations, activities in general practice) was compared by multimorbidity categories and SEP by using negative binomial regression model. The association between of SEP, multimorbidity and prognostic outcomes were analyzed using Cox proportional hazards regression. We followed 2.007 patients (median age of 70), 79% were males, 75% were on early retirement or state pension, 37% were living alone, and 41% had low education level) for 5.2 (IQR; 2.2-7.3) years. In adjusted regression models, higher number of chronic conditions were associated with increased health care utilization. Both cardiovascular and non-cardiovascular hospital contacts were increased. Patients with low SEP had higher number of chronic conditions, but SEP had limited influence on health care utilization. Patients living alone and those with low educational level had a trend towards higher risk of all-cause mortality (adjusted hazard ratio: 1.17, 95% confidence interval [CI] 1.03-1.33 and 1.09, 95% CI 0.96-1.24). Multimorbidity increased the use of cross-sectional health care services, whereas low SEP had minor influence on the utilizations. Living alone and low educational level showed a trend toward higher risk of mortality after CRT implantation.