Cardiometabolic multimorbidity and the risk of sudden cardiac death among geriatric community dwellers using longitudinal EHR-derived data

Yue Li ^1,2 Zihan Mei ² Zhengkun Liu ² Ji Li ² Guolei Sun ³ Marcus Eng Ong ^4,5 Haojun Fan ^2* Chunxia Cao ^2*

• ¹ College of Management and Economics, Tianjin University, Nankai, Tianjin, China
• ² School of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
• ³ Jinnan Hospital, Tianjin University, Tianjin, China
• ⁴ Dept of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
• ⁵ Health Services and Systems Research, Duke NUS Medical School, Singapore, Singapore

Background: Cardiometabolic multimorbidity (CMM) has increased globally in recent years, especially among geriatric community dwellers. However, it is currently unclear how SCD risk is impacted by CMM in older adults. This study aimed to examine the associations between CMM and SCD among geriatric community dwellers in a province of China.Methods: This study was a retrospective, population-based cohort design based on electronic health records (EHRs) of geriatric community dwellers (≥65 years old) in four towns of Tianjin, China. 55,130 older adults were included in our study. Older adults were categorized into different CMM patterns according to the cardiometabolic disease (CMD) status at baseline. The count of CMDs was also entered as a continuous variable to examine the potential additive effect of CMM on SCD. Cox proportional hazard models were used to evaluate associations between CMM and SCD. The results are expressed as hazard ratios (HRs) and 95% confidence intervals (CIs).Results: The prevalence of CMM was approximately 25.3% in geriatric community dwellers. Among participants with CMM, hypertension and diabetes was the most prevalent combination (9,379, 17.0%). The highest crude mortality rates for SCD were 7.5 (2.9, 19.1) per 1000 personyears in older adults with hypertension, coronary heart disease, diabetes and stroke (HR, 4.496; 95% CI, 1.696, 11.917), followed by those with hypertension, coronary heart disease, and stroke (HR, 3.290; 95% CI, 1.056, 10.255). The risks of SCD were significantly increased with increasing numbers of CMDs (HR, 1.787; 95% CI, 1.606, 1.987). The demographic, risk factors, serum measures and ECG-adjusted HR for SCD was 1.488 (1.327, 1.668) for geriatric community dwellers with an increasing number of CMDs.Conclusion: The risk of SCD varied by the pattern of CMM, and increased with increasing number of CMM among geriatric community dwellers.