Informing clinical practice guideline development and implementation: Prevalence of coexisting conditions among adults with coronary heart disease

Objectives: To describe the prevalence of coexisting conditions that affect clinical decision-making in adults with coronary heart disease (CHD). Design: Cross-sectional. Setting: National Health and Nutrition Examination Survey, 1999 to 2004. Participants: Eight thousand six hundred fifty-four people aged 45 and older; 1,259 with CHD. Measurements: Coexisting conditions relevant to clinical decision-making and implementing therapy for CHD across three domains: chronic diseases, self-reported and laboratory-based clinical measures, and health status factors of self-reported and observed function. Prevalence was estimated according to sex and age, mutually exclusive patterns were examined, and the odds ratios (OR) of having incurred repeated hospitalization in the last year of participants with CHD and each complexity pattern versus CHD alone were modeled. Results: The prevalence of comorbid chronic diseases in subjects with CHD was 56.7% for arthritis, 29.0% for congestive heart failure, 25.5% for chronic lower respiratory tract disease, 24.8% for diabetes mellitus, and 13.8% for stroke. Clinical factors adding to complexity of clinical decision-making for CHD were use of more than four medications (54.5%), urinary incontinence (48.6%), dizziness or falls (34.8%), low glomerular filtration rate (24.4%), anemia (10.1%), high alanine aminotransferase (5.9%), use of warfarin (10.2%), and health status factors were cognitive impairment (29.9%), mobility difficulty (40.4%), frequent mental distress (14.3%), visual impairment (16.7%), and hearing impairment (17.9%). Several comorbidity patterns were associated with high odds of hospitalization. Conclusion: Coexisting conditions that may modify the effectiveness of or interact with CHD therapies, influence the feasibility of CHD therapies, or alter patients' priorities concerning their health care should be considered in the development of trials and guidelines to better inform real-world clinical decision-making.