Musculoskeletal comorbidities in cardiac patients: prevalence, predictors, and health services utilization

Marzolini S, Oh PI, Alter D, Stewart DE, Grace SL; on behalf of the Cardiac Rehab: Care Continuity through Automatic Referral Evaluation Investigators. Musculoskeletal comorbidities in cardiac patients: prevalence, predictors, and health services utilization.ObjectivesTo describe the prevalence of musculoskeletal conditions (MSKC) in patients with coronary artery disease (CAD); to examine the sociodemographic, clinical, and psychosocial predictors of these comorbidities; and to describe health care utilization by musculoskeletal comorbidity status.DesignThis was a cross-sectional, observational study in which patients were administered a questionnaire in the hospital and 1 year later.SettingEleven hospitals in Ontario, Canada.ParticipantsCAD patients (N=1803).InterventionsNot applicable.Main Outcome MeasuresSociodemographic, MSKC, clinical, and psychosocial factors were ascertained via questionnaire and in-hospital chart extraction. A health care utilization questionnaire was mailed 1 year later.ResultsOver half (56%) of the patients with CAD had MSKCs, with arthritis/joint pain accounting for 64.4% of these MSKCs. Patients who were older (odds ratio OR]=1.03), women (OR=1.87), white (OR=1.80), with higher body mass index (OR=1.05), depressive symptoms (OR=1.92), and lower family income (OR=1.46) were more likely to present with MSKCs. One year posthospitalization, a greater proportion of those with MSKCs reported ≥1 cardiac-related emergency department visit (33.2% vs 28.3%, P=.03), hospital admission (30.7% vs 22%, P=.006), more primary care physician visits (6.6±5.6 vs 5.7±4.6, P<.001), and fewer cardiac rehabilitation referrals (61.5% vs 70%, P<.001). After adjusting for depressive symptoms, body mass index, age, income, ethnicity, and sex, MSKCs predicted only hospital readmissions.ConclusionsOver half of the patients hospitalized for CAD have MSKCs. Those with MSKCs have a physical and psychosocial profile that places them at greater cardiovascular risk than those with CAD only, explaining, in part, their greater health care utilization. Despite a greater need for comprehensive risk factor management in patients with MSKCs, fewer were referred to cardiac rehabilitation.