title: Musculoskeletal comorbidities in cardiac patients: prevalence, predictors, and health services utilization.
abstract: OBJECTIVE
  To describe the prevalence of musculoskeletal conditions (MSKC) in patients with coronary artery disease (CAD); to examine the sociodemographic, clinical, and psychosocial predictors of these comorbidities; and to describe health care utilization by musculoskeletal comorbidity status.
  
  
  METHODS
  This was a cross-sectional, observational study in which patients were administered a questionnaire in the hospital and 1 year later.
  
  
  METHODS
  Eleven hospitals in Ontario, Canada.
  
  
  METHODS
  CAD patients (N=1803).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Sociodemographic, MSKC, clinical, and psychosocial factors were ascertained via questionnaire and in-hospital chart extraction. A health care utilization questionnaire was mailed 1 year later.
  
  
  RESULTS
  Over half (56%) of the patients with CAD had MSKCs, with arthritis/joint pain accounting for 64.4% of these MSKCs. Patients who were older (odds ratio [OR]=1.03), women (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 posthospitalization, a greater proportion of those with MSKCs reported ≥1 cardiac-related emergency department visit (33.2% vs 28.3%, P=.03), hospital admission (30.7% vs 22%, P=.006), more primary care physician visits (6.6±5.6 vs 5.7±4.6, P<.001), and fewer cardiac rehabilitation referrals (61.5% vs 70%, P<.001). After adjusting for depressive symptoms, body mass index, age, income, ethnicity, and sex, MSKCs predicted only hospital readmissions.
  
  
  CONCLUSIONS
  Over half of the 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 health care utilization. Despite a greater need for comprehensive risk factor management in patients with MSKCs, fewer were referred to cardiac rehabilitation.
authors.affiliation: Toronto Rehabilitation Institute, Toronto, ON, Canada. Marzolini.susan@torontorehab.on.ca
authors.forename: Susan
authors.initials: S
authors.lastname: Marzolini
authors.forename: Paul I
authors.initials: PI
authors.lastname: Oh
authors.forename: David
authors.initials: D
authors.lastname: Alter
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000453:epidemiology; D001168:Arthritis / Q000453:epidemiology; D015992:Body Mass Index; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology* / Q000523:psychology; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data; D009864:Ontario / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012737:Sex Factors