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. 2021;6:e210006.
doi: 10.20900/jpbs.20210006. Epub 2021 Apr 13.

Psychosocial Syndemics and Multimorbidity in Patients with Heart Failure †

Kenneth E Freedland  1 , Judith A Skala  1 , Robert M Carney  1 , Brian C Steinmeyer  1 , Michael W Rich  2
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Free PMC article

Psychosocial Syndemics and Multimorbidity in Patients with Heart Failure †

Kenneth E Freedland et al. J Psychiatr Brain Sci. 2021.
Free PMC article

Abstract

Heart failure (HF) is a common cause of hospitalization and mortality in older adults. HF is almost always embedded within a larger pattern of multimorbidity, yet many studies exclude patients with complex psychiatric and medical comorbidities or cognitive impairment. This has left significant gaps in research on the problems and treatment of patients with HF. In addition, HF is only one of multiple challenges facing patients with multimorbidity, stressful socioeconomic circumstances, and psychosocial problems. The purpose of this study is to identify combinations of comorbidities and health disparities that may affect HF outcomes and require different mixtures of medical, psychological, and social services to address. The syndemics framework has yielded important insights into other disorders such as HIV/AIDS, but it has not been applied to the complex psychosocial problems of patients with HF. The multimorbidity framework is an alternative approach for investigating the effects of multiple comorbidities on health outcomes. The specific aims are: (1) to determine the coprevalence of psychiatric and medical comorbidities in patients with HF (n = 535); (2) to determine whether coprevalent comorbidities have synergistic effects on readmissions, mortality, self-care, and global health; (3) to identify vulnerable subpopulations of patients with HF who have high coprevalences of syndemic comorbidities; (4) to determine the extent to which syndemic comorbidities explain adverse HF outcomes in vulnerable subgroups of patients with HF; and (5) to determine the effects of multimorbidity on readmissions, mortality, self-care, and global health.

Keywords: comorbidity; health status disparities; heart failure; mental disorders; multimorbidity; patient readmission; self-care; self-management; social determinants of health; syndemic.

Conflict of interest statement

CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Comorbidity among chronic conditions for Medicate Fee-for-Service beneficiaries (2017) [87].
Figure 2.
Figure 2.
Distribution of Medicare Fee-for-Service beneficiaries and Medicare spending by number of chronic conditions (2017) [87].
Figure 3.
Figure 3.
Distribution of Medicare Fee-for-Service beneficiaries and 30-day Medicare hospital readmissions by number of chronic conditions (2017) [87].
See this image and copyright information in PMC

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