Keywords: Multimorbidity, Treatment burden, Quality of life, Heart failure, Chronic kidney diseases, Primary health care.

Background:

Management of patients with multimorbidity is a frequent challenge in primary care. Multimorbidity increases the day-to-day workload imposed by treatment-related tasks (treatment burden) and reduces health-related quality of life (HRQoL).

Research questions:

However, the relationship between specific constellations of chronic conditions and both treatment burden and HRQoL in patients with multimorbidity remains insufficiently understood.

Method:

This study was conducted in 2021–2023 within the EUFIAP TELELISPA project (Nr. 08.4.2-ESFA-K-616-01-0003) across seven primary healthcare centers in Lithuania. We included 789 adults with multimorbidity (≥2 chronic conditions), one of which was arterial hypertension. Treatment burden was assessed using the Multimorbidity Treatment Burden Questionnaire (MTBQ), and HRQoL using the EQ-5D-5L.

Results:

Treatment burden categories were: high 9.0%; moderate 25.0%; low 46.6% and no treatment burden 19.4%. A higher likelihood of greater treatment burden was observed in patients with heart failure (p = 0.009) and chronic kidney disease (p = 0.011) and was also associated with greater clinical complexity (more chronic conditions, polypharmacy, anxiety/depression) and rural residence. Overall, HRQoL was significantly poorer in patients with angina pectoris (p = 0.025), heart failure (p = 0.026), and atrial fibrillation (p = 0.016). Heart failure was associated with worse outcomes in mobility p < 0.001; self-care p = 0.006; usual activities p < 0.001; anxiety/depression p < 0.001. Atrial fibrillation was associated with worse mobility (p = 0.004) and anxiety/depression (p = 0.035). Chronic kidney disease was associated with poorer usual activities (p = 0.016), asthma/COPD with poorer usual activities (p = 0.005), and diabetes with greater pain/discomfort (p = 0.013). The strongest negative impact on HRQoL was observed for heart failure and joint diseases, and in older patients.

Conclusions:

Heart failure and chronic kidney disease are key markers of higher treatment burden among patients with multimorbidity, while cardiovascular and musculoskeletal conditions are most strongly associated with poorer HRQoL.

Points for discussion: