Prevalence of musculoskeletal comorbidities in cardiac patients: A prospective investigation of correlates and health services utilization.

Objectives: To describe the prevalence of musculoskeletal conditions (MSKC) in patients with coronary artery disease (CAD), examine the sociodemographic, clinical and psychosocial predictors of these comorbidities, and describe healthcare utilization by MSK comorbidity status. Design/Participants: 1803 patients in whom a cardiac condition was the reason for hospital admission, were administered a questionnaire in hospital and 1 year later. Setting: Eleven hospitals in Ontario, Canada. Outcome Measures: Sociodemographic, MSKC, clinical and psychosocial factors were ascertained via questionnaire and in-hospital chart extraction. A healthcare utilization questionnaire was mailed 1 year later. Results: Over half (56%) of patients with CAD had MSKCs, with arthritis/joint pain accounting for 64.4% of these MSKCs. Patients who were older (OR=1.03), female (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 post-hospitalization, a greater proportion of those with MSKCs reported ≥1 cardiac-related emergency department visit (33.2 vs. 28.3%,p=0.03), hospital admission (30.7 vs. 22%, p=0.006), more primary care physician visits (6.6 ± 5.6 vs. 5.7 ± 4.6, p<0.001) and fewer cardiac rehabilitation referrals (61.5 vs. 70%, p<0.001). After adjusting for depressive symptoms, body mass index, age, income, ethnicity, and sex, MSKCs predicted only hospital readmissions. Conclusions: Over half of 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 healthcare utilization. Despite a greater need for comprehensive risk factor management in patients with MSKCs, fewer were referred to cardiac rehabilitation.