Which multimorbidity clusters in hypertensive patients are associated with longer hospital stays?
Authors: Wleklik M , Juarez-Vela R , Uchmanowicz I , Czapla M , Uchmanowicz B 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The number of people with hypertension will increase by 15-20% by 2025. Research shows that up to two thirds of hypertensive patients have other comorbidities. Multimorbidity defined as the coexistence of two or more diseases in the same person, is now a common phenomenon. Patients with multimorbidity have poorer health outcomes and are more likely to use unscheduled hospital healthcare. By identifying hypertensive clusters, their need for hospital care and the cost of care can be determined. Patient profiling has the potential to improve treatment outcomes and increase the efficiency of care.

Purpose
Identification and characterization of multimorbidity clusters in hypertensive patients and assessment of which of them were responsible for longer hospitalization.

Material and Methods
Data from 489 patients admitted to the cardiology department with hypertension as the main diagnosis over three years was used for the analysis. 163 patients (81 women, 82 men, mean age 63.93 ± 11.49) had multiple conditions (≥ 2 conditions). Patient profiles for each group were described by age, gender, hypertension grade and length of hospital stay. Partitioning Around Medoids method was used to divide patients into clusters. Dissimilarity between patients was measured with Gower distance. Number of clusters was determined using Silhouette method. Significance level for all statistical tests was set to 0.05.

Results
Hypertensive patients reported comorbidities such as heart failure (14%), diabetes (28%), chronic kidney disease (14%), stroke (12%), acute coronary syndrome (8%), obesity (37%). There were 12 clusters for the study group: (1) without comorbidities, (2) obesity only, (3) obesity and diabetes mellitus (DM),(4) heart failure (HF) and chronic kidney disease (CKD),(5) DM,(6) acute coronary syndrome (ACS),(7) obesity, stroke, and DM,(8) CKD and other diseases without HF,(9) obesity and ACS, (10) stroke, (11) HF and obesity,(12) DM, HF and often obesity. It was noted that ACS patients significantly older than patients without comorbidities and from patients in clusters 2, 3, 7, 8 and 10. In addition, patients with DM only and patients with DM, HF and obesity were significantly older than patients who were only obese. Hospitalization time was significantly longer in patients with HF than in patients from clusters 1, 2, 5, 7, 10. Significantly longer in patients with CKD but without HF than in clusters 1, 5, 7. Significantly longer in patients with HF and obesity than in clusters 1 and 7. Significantly longer in patients with obesity and DM and in patients with DM, HF and often obesity than in patients without comorbidities.

Conclusions
Comorbidities affect the length of hospitalization of patients with hypertension. Comorbidities such as HF, CKD, DM and obesity will prolong the hospitalization of hypertensive patients. Clinical profiles of patients allow forecasting the need for longer and more expensive medical care.