RT Journal Article SR Electronic T1 Multimorbidity patterns in patients with heart failure: an observational Spanish study based on electronic health records JF BMJ Open JO BMJ Open FD British Medical Journal Publishing Group SP e033174 DO 10.1136/bmjopen-2019-033174 VO 9 IS 12 A1 Antonio Gimeno-Miguel A1 Anyuli Gracia Gutiérrez A1 Beatriz Poblador-Plou A1 Carlos Coscollar-Santaliestra A1 J Ignacio Pérez-Calvo A1 Miguel J Divo A1 Amaia Calderón-Larrañaga A1 Alexandra Prados-Torres A1 Fernando J Ruiz-Laiglesia YR 2019 UL http://bmjopen.bmj.com/content/9/12/e033174.abstract AB Objectives To characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the impact of such patterns on the risk of hospitalisation and mortality.Design Observational retrospective population study based on electronic health records.Setting EpiChron Cohort (Aragón, Spain).Participants All the primary and hospital care patients of the EpiChron Cohort with a diagnosis of HF on 1 January 2011 (ie, 8488 women and 6182 men). We analysed all the chronic diseases registered in patients’ electronic health records until 31 December 2011.Primary outcome We performed an exploratory factor analysis to identify the multimorbidity patterns in men and women, and logistic and Cox proportional-hazards regressions to investigate the association between the patterns and the risk of hospitalisation in 2012, and of 3-year mortality.Results Almost all HF patients (98%) had multimorbidity, with an average of 7.8 chronic diseases per patient. We identified six different multimorbidity patterns, named cardiovascular, neurovascular, coronary, metabolic, degenerative and respiratory. The most prevalent were the degenerative (64.0%) and cardiovascular (29.9%) patterns in women, and the metabolic (49.3%) and cardiovascular (43.2%) patterns in men. Every pattern was associated with higher hospitalisation risks; and the cardiovascular, neurovascular and respiratory patterns significantly increased the likelihood of 3-year mortality.Conclusions Multimorbidity is the norm rather than the exception in patients with heart failure, whose comorbidities tend to cluster together beyond simple chance in the form of multimorbidity patterns that have different impact on health outcomes. This knowledge could be useful to better understand common pathophysiological pathways underlying this condition and its comorbidities, and the factors influencing the prognosis of men and women with HF. Further large scale longitudinal studies are encouraged to confirm the existence of these patterns as well as their differential impact on health outcomes.