In This Issue: Challenges of Managing Multimorbidity

Stange, Kurt C.

doi:10.1370/afm.1354

Cited by 24 publications

(18 citation statements)

References 20 publications

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“…[34–36], published data on cardiovascular diseases in MM are scarce. In the primary health care setting, however, the MM approach has been recommended as more suitable than focusing on one specific disease [3, 37]. …”

Section: Discussionmentioning

confidence: 99%

The burden of cardiovascular morbidity in a European Mediterranean population with multimorbidity: a cross-sectional study

et al. 2016

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BackgroundCardiovascular diseases are highly represented in multimorbidity patterns. Nevertheless, few studies have analysed the burden of these diseases in the population with multimorbidity. The objective of this study was to identify and describe the cardiovascular diseases among the patients with multimorbidity.MethodsWe designed a cross-sectional study in patients ≥19 years old assigned to 251 primary health care centres in Catalonia, Spain. The main outcome was cardiovascular morbidity burden, defined as the presence of one or more of 24 chronic cardiovascular diseases in multimorbid patients (≥2 chronic conditions). Two groups were defined, with and without multimorbidity; the multimorbidity group was further divided into cardiovascular and non-cardiovascular subgroups. The secondary outcomes were: modifiable major cardiovascular risk factors (smoking, hypertension, hypercholesterolaemia, diabetes) and cardiovascular risk score (REGICOR, Registre Gironí del Cor). Other variables analysed were: sex, age (19–24, 25–44, 45–64, 65–79, and 80+ years), number of chronic diseases, urban setting, active toxic habits (smoking and alcohol), physical parameters and laboratory tests.ResultsA total of 1,749,710 individuals were included (mean age, 47.4 years [SD: 17.8]; 50.7 % women), of which nearly half (46.8 %) had multimorbidity (95 % CI: 46.9–47.1). In patients with multimorbidity,, the cardiovascular burden was 54.1 % of morbidity (95 % CI: 54.0–54.2) and the four most prevalent cardiovascular diseases were uncomplicated hypertension (75.3 %), varicose veins of leg (20.6 %), “other” heart disease (10.5 %) and atrial fibrillation/flutter (6.7 %). In the cardiovascular morbidity subgroup, 38.2 % had more than one cardiovascular disease. The most prevalent duet and triplet combinations were uncomplicated hypertension & lipid disorder (38.8 %) and uncomplicated hypertension & lipid disorder & non-insulin dependent diabetes (11.3 %), respectively. By age groups, the same duet was the most prevalent in patients aged 45–80 years and in men aged 25–44 years. In women aged 19–44, varicose veins of leg & anxiety disorder/anxiety was the most prevalent; in men aged 19–24, it was uncomplicated hypertension & obesity. Patients with multimorbidity showed a higher cardiovascular risk profile than the non-multimorbidity group.ConclusionsMore than 50 % percent of patients with multimorbidity had cardiovascular diseases, the most frequent being hypertension. The presence of cardiovascular risk factors and the cardiovascular risk profile were higher in the multimorbidity group than the non-multimorbidity group. Hypertension, diabetes and dyslipidaemia constituted the most prevalent multimorbidity pattern.

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Section: Discussionmentioning

confidence: 99%

The burden of cardiovascular morbidity in a European Mediterranean population with multimorbidity: a cross-sectional study

et al. 2016

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“…As highlighted in some recent reviews, multimorbidity has been regarded as a major research priority [13], yet the number and diversity of evaluations on multimorbidity have been insufficient to provide robust scientific evidence in guiding patient care [14]. The WHO called for action to prioritize healthcare resources for global management of chronic diseases in the next decade, and there is a universal consensus that the topic of multimorbidity should be a central focus of attention [15,16]. We have previously conducted studies on multimorbidity [17][18][19] and medication adherence [20][21][22][23][24][25] among hypertensive patients, yet most of them either relied on retrospective data [17,[21][22][23][24]; or were small-scaled [19,20].…”

Section: Introductionmentioning

confidence: 99%

The association between multimorbidity and poor adherence with cardiovascular medications

Wong

Liu

Zhou

et al. 2014

International Journal of Cardiology

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“…Our findings underscore the importance of the association between multimorbidity burden and adverse outcomes in individuals with various types of HF, middle‐aged and older persons, and men and women. Multimorbidity in individuals with HF substantially increases the complexity of their care, as practitioners face the challenge of managing multiple conditions simultaneously that may increase therapy‐associated side effects . With the aging of the U.S. population, the numbers of individuals with HF will increase dramatically over the coming decades, especially those with a high burden of multimorbidity, which will place greater demands on healthcare providers and the systems in which they work.…”

Section: Discussionmentioning

confidence: 99%

“…Multimorbidity in individuals with HF substantially increases the complexity of their care, as practitioners face the challenge of managing multiple conditions simultaneously that may increase therapy-associated side effects. 4,28,[32][33][34][35] With the aging of the U.S. population, the numbers of individuals with HF will increase dramatically over the coming decades, 1,2 especially those with a high burden of multimorbidity, which will place greater demands on healthcare providers and the systems in which they work. A clearer understanding of the effect of multimorbidity burden on important outcomes in individuals with HF will help healthcare providers and their patients and their caregivers in discussions about their prognosis.…”

Section: Discussionmentioning

confidence: 99%

Multimorbidity Burden and Adverse Outcomes in a Community‐Based Cohort of Adults with Heart Failure

Tisminetzky

Gurwitz

Fan

et al. 2018

J American Geriatrics Society

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OBJECTIVES: To assess the multimorbidity burden and its association with clinical outcomes in adults with heart failure (HF) according to sex, age, and HF type. DESIGN: Retrospective cohort study. SETTING and PARTICIPANTS: 114, 553 adults with HF from five healthcare delivery systems across the U.S. MEASUREMENTS: We characterized patients with respect to the presence of 26 chronic conditions categorized into quartiles based on overall burden of comorbidity (0–4, 5–6, 7–8, ≥9). Outcomes included all-cause death and hospitalizations for HF or any cause. Multivariable Cox regression was used to evaluate the adjusted association of categorized burden of multimorbidity burden with outcomes. RESULTS: Among 114,553 adults with HF, adjusted hazard ratios (HR) for all-cause death among those with 5–6, 7–8, or 9 or more morbidities (vs. 0–4) were HR 1.27 (95% CI, 1.24–1.31), HR 1.52 (95% CI, 1.48–1.57), and HR 1.92 (95% CI, 1.86–1.99), respectively. There was a graded, higher adjusted rate of any-cause hospitalization associated with 5–6, 7–8, or 9 or more morbidities (vs. 0–4): HR 1.28 (95% CI, 1.25–1.30), HR 1.47 (95% CI, 1.44–1.50), and HR 1.77 (95% CI, 1.73–1.82), respectively. Similar findings were observed for HF-specific hospitalization in those with 5–6, 7–8, or 9 or more morbidities (vs. 0–4): HR 1.22 (95% CI, 1.19–1.26), HR 1.39 (95% CI, 1.34–1.44), and HR 1.68 (95% CI, 1.61–1.74), respectively. Consistent findings were seen by sex, age group and HF type (preserved, reduced, borderline HF), with the relationship between categorical burden of multimorbidity and outcomes especially prominent among those <65 years. CONCLUSION: After adjustment higher levels of multimorbidity predict worse HF outcomes and may be an important consideration in strategies to improve clinical and patient-centered outcomes.

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In This Issue: Challenges of Managing Multimorbidity

Cited by 24 publications

References 20 publications

The burden of cardiovascular morbidity in a European Mediterranean population with multimorbidity: a cross-sectional study

The burden of cardiovascular morbidity in a European Mediterranean population with multimorbidity: a cross-sectional study

The association between multimorbidity and poor adherence with cardiovascular medications

Multimorbidity Burden and Adverse Outcomes in a Community‐Based Cohort of Adults with Heart Failure

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