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Nursing Research and Practice
Volume 2013, Article ID 563246, 11 pages
Review Article

Measuring Comorbidity in Cardiovascular Research: A Systematic Review

1School of Nursing, The Pennsylvania State University, 201 Health and Human Development East, University Park, PA 16802, USA
2School of Nursing, Duke University, Duke University Medical Center 3322, 307 Trent Drive, Durham, NC 27710, USA

Received 23 May 2013; Accepted 24 June 2013

Academic Editor: Victoria Vaughan Dickson

Copyright © 2013 Harleah G. Buck et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Everything known about the roles, relationships, and repercussions of comorbidity in cardiovascular disease is shaped by how comorbidity is currently measured. Objectives. To critically examine how comorbidity is measured in randomized controlled trials or clinical trials and prospective observational studies in acute myocardial infarction (AMI), heart failure (HF), or stroke. Design. Systematic review of studies of hospitalized adults from MEDLINE CINAHL, PsychINFO, and ISI Web of Science Social Science databases. At least two reviewers screened and extracted all data. Results. From 1432 reviewed abstracts, 26 studies were included (AMI , HF , stroke ). Five studies used an instrument to measure comorbidity while the remaining used the presence or absence of an unsubstantiated list of individual diseases. Comorbidity data were obtained from 1–4 different sources with 35% of studies not reporting the source. A year-by-year analysis showed no changes in measurement. Conclusions. The measurement of comorbidity remains limited to a list of conditions without stated rationale or standards increasing the likelihood that the true impact is underestimated.