Risk factors for decompensation among multimorbid patients: analysis of a French Cohort with a 24-month follow-up.

Abstract

Aim: The European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. Identification of risk factors for decompensation would be an interesting challenge for family physicians (FPs) in the management of multimorbid patients. The aim was to assess which items from the EGPRN's definition of multimorbidity could identify outpatients at risk of decompensation at 24 months.

Methods: A cohort study. About 120 multimorbid patients from Western Brittany, France, were included by general practitioners between 2014 and 2015. The status "decompensation" (hospitalization of at least 7 days or death) or "nothing to report (NTR)" was collected at 24 months of follow-up.

Findings: At 24 months, there were 44 patients (36.6%) in the decompensation group. Two variables were significant risk factors for decompensation: the number of visits to the FP per year (HR = 1.06 [95% CI 1.03-1.10], P < 0.001) and the total number of diseases (HR = 1.12 [95% CI 1.013-1.33], P = 0.039).

Conclusion: FPs should be warned that a high number of consultations and a high total number of diseases may predict death or hospitalization. These results need to be confirmed by large-scale cohorts in primary care.