What multimorbidity means for people arriving at the emergency department
In a study of 451,291 people, those with several long-term conditions were far more likely to die within 30 days, and the link was stronger in people under 65.
The question
Many people who attend emergency departments live with several long-term conditions at once, known as multimorbidity. How does that affect what happens to them afterwards?
What we did
As part of the NIHR-funded AIM-CISC project, colleagues led by the University of Edinburgh, with us, studied 451,291 people who made 1,273,937 emergency department attendances. Multimorbidity meant at least two conditions from a standard list. We looked at 30-day mortality, hospital admission, return within seven days and time spent in the department.
What we found
About one in ten patients, 9.6%, had multimorbidity. They were older, more often arrived by emergency ambulance and were more often triaged as very urgent. After adjustment, multimorbidity was linked to higher 30-day mortality (8.2% versus 1.2%), more hospital admissions (60.1% versus 20.5%), more returns within seven days and longer stays. The associations were stronger in younger people: for 30-day mortality the adjusted odds ratio was 3.03 for those under 65 and 1.61 for those 65 or older.
Why it matters
Multimorbidity is common in emergency care and strongly linked to poor outcomes, and it is increasing, so services need to plan for it.