# Psychosocial Syndemics and Multimorbidity in Hospitalized Patients with Heart Failure

> **NIH NIH R01** · WASHINGTON UNIVERSITY · 2021 · $763,325

## Abstract

Approximately 6.2 million Americans have heart failure (HF) and the prevalence is increasing rapidly. HF is a
common cause of hospitalization and mortality in older adults, and the cost of hospital care for HF is
skyrocketing. One reason why HF is so burdensome and costly is that it is often complicated by cardiovascular
and noncardiovascular comorbidities, especially in older patients. Psychiatric and medical disorders that are
risk factors for incident HF persist after HF has developed, and additional comorbidities accumulate as patients
with HF grow older. Thus, HF is embedded within a larger pattern of multimorbidity. Unfortunately, most trials
of HF therapies as well as many other studies of HF have excluded patients with complex psychiatric and
medical comorbidities or severe cognitive impairment. This has left large gaps in research on the care of older
adults with HF. In addition, research on socioeconomic risk factors and health disparities has not been
integrated with research on multimorbidity in HF. Heart failure is only one of multiple challenges facing patients
with multimorbidity, stressful socioeconomic circumstances, and psychosocial problems, but the fragmentation
of research on HF has left us with little understanding of patients with complex psychosocial problems. The
purpose of this study is to identify combinations of comorbidities and health disparities may affect HF outcomes
and require different mixtures of medical, psychological, and social services to address. It will encompass both
psychiatric and medical comorbidities but will emphasize the role of psychiatric comorbidities. Syndemics
theory is a useful framework for studying this type of psychosocial and medical complexity. Syndemics, also
known as synergistic epidemics, occur when there are adverse interactions between prevalent disorders that
concentrate in populations that are vulnerable due to adverse socioeconomic or environmental conditions. The
syndemics framework has yielded important insights into a number of other disorders, but it has not been used
to study the complex psychosocial problems of patients with HF. To our knowledge, this will be the first study
of the syndemics of psychiatric and medical comorbidities in heart failure. The multimorbidity framework is an
alternative approach for investigating the effects of multiple comorbidities on health outcomes. The specific
aims of the study are: 1) to determine the coprevalence of major psychiatric and medical comorbidities in
hospitalized patients with HF (n=535); 2) to determine whether coprevalent comorbidities have synergistic
effects on 30-day all-cause readmission and mortality risks, heart failure self-care, and health-related quality of
life; 3) to identify vulnerable subpopulations of hospitalized patients with HF who have higher coprevalences of
syndemic comorbidities compared to less vulnerable subpopulations; 4) to determine the extent to which
syndemic comorbidities explain adverse HF outcome...

## Key facts

- **NIH application ID:** 10204105
- **Project number:** 5R01HL151431-02
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** KENNETH E FREEDLAND
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $763,325
- **Award type:** 5
- **Project period:** 2020-07-01 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10204105

## Citation

> US National Institutes of Health, RePORTER application 10204105, Psychosocial Syndemics and Multimorbidity in Hospitalized Patients with Heart Failure (5R01HL151431-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10204105. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*