Multimorbidity in Older Patients with Cardiovascular Disease

Dunlay, Shannon M.; Chamberlain, Alanna M.

doi:10.1007/s12170-016-0491-8

Cited by 65 publications

(54 citation statements)

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“…Clinical practice guidelines are usually made for a single disease condition, since clinical trials usually include patients with a single disease entity. [ 27 ] Strategies are being implemented in order to account for comorbidities in the management of patients with CV disease[ 28 ]. More studies are needed to test specific secondary prevention programmes for ACS patients with multiple comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome

et al. 2018

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ObjectiveTo examine the prognosis of patients with cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome compared to patients without prior multimorbidity.MethodsThis multicenter prospective cohort study in Switzerland included 5,635 patients hospitalized with acute coronary syndrome between 2009 and 2014, with a one-year follow-up period. We defined cardiovascular and non-cardiovascular multimorbidity as having at least two prior comorbidities before the index hospitalization. Multivariable adjusted Cox proportional models were built to assess the one-year risk of recurrent cardiovascular events, defined as cardiovascular mortality and non-fatal myocardial infarction or stroke. The final model was adjusted for age, gender, body mass index, tobacco consumption, education, and family history of cardiovascular disease, prescription of high-dose statinsat discharge and use of cardiac rehabilitation after discharge.ResultsOverall, 3,664 patients (65%) had no multimorbidity, 1,839 (33%) had cardiovascular multimorbidity, 62 (1%) had non-cardiovascular multimorbidity, and 70 (1%) had both cardiovascular and non-cardiovascular multimorbidity. The multivariate risk of recurrent cardiovascular events was increased among patients with cardiovascular multimorbidity (hazard ratio (HR) 2.05, 95% CI: 1.54–2.73, p<0.001) and patients with non-cardiovascular multimorbidity (HR 2.57, 95% CI: 1.04–6.35, p = 0.04) compared to patients without multimorbidity. Patients with cardiovascular and non-cardiovascular multimorbidity had the highest risk of recurrence with a HR of 5.19, 95% CI: 2.79–9.64, p<0.001, compared to patients without multimorbidity.ConclusionsMultimorbidity increased by two-fold the risk of cardiovascular events over the year after an acute coronary syndrome. The magnitude of this increased risk was similar for patients with cardiovascular or non-cardiovascular multimorbidity.

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Section: Discussionmentioning

confidence: 99%

Prognosis of cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome

et al. 2018

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“…Despite the importance of this issue, to our knowledge, no previous study has investigated the patterns and temporal trends in comorbidity among incident CVD patients, and reports of the presence of comorbidities among patients with prevalent CVD have been typically confined to investigation of a few chronic conditions [ 6 , 7 ], limited to specific subgroups [ 8 , 9 ], or based on information from hospital admissions, which may miss reports on important outpatient diagnoses [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Patterns and temporal trends of comorbidity among adult patients with incident cardiovascular disease in the UK between 2000 and 2014: A population-based cohort study

et al. 2018

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BackgroundMultimorbidity in people with cardiovascular disease (CVD) is common, but large-scale contemporary reports of patterns and trends in patients with incident CVD are limited. We investigated the burden of comorbidities in patients with incident CVD, how it changed between 2000 and 2014, and how it varied by age, sex, and socioeconomic status (SES).Methods and findingsWe used the UK Clinical Practice Research Datalink with linkage to Hospital Episode Statistics, a population-based dataset from 674 UK general practices covering approximately 7% of the current UK population. We estimated crude and age/sex-standardised (to the 2013 European Standard Population) prevalence and 95% confidence intervals for 56 major comorbidities in individuals with incident non-fatal CVD. We further assessed temporal trends and patterns by age, sex, and SES groups, between 2000 and 2014. Among a total of 4,198,039 people aged 16 to 113 years, 229,205 incident cases of non-fatal CVD, defined as first diagnosis of ischaemic heart disease, stroke, or transient ischaemic attack, were identified. Although the age/sex-standardised incidence of CVD decreased by 34% between 2000 to 2014, the proportion of CVD patients with higher numbers of comorbidities increased. The prevalence of having 5 or more comorbidities increased 4-fold, rising from 6.3% (95% CI 5.6%–17.0%) in 2000 to 24.3% (22.1%–34.8%) in 2014 in age/sex-standardised models. The most common comorbidities in age/sex-standardised models were hypertension (28.9% [95% CI 27.7%–31.4%]), depression (23.0% [21.3%–26.0%]), arthritis (20.9% [19.5%–23.5%]), asthma (17.7% [15.8%–20.8%]), and anxiety (15.0% [13.7%–17.6%]). Cardiometabolic conditions and arthritis were highly prevalent among patients aged over 40 years, and mental illnesses were highly prevalent in patients aged 30–59 years. The age-standardised prevalence of having 5 or more comorbidities was 19.1% (95% CI 17.2%–22.7%) in women and 12.5% (12.0%–13.9%) in men, and women had twice the age-standardised prevalence of depression (31.1% [28.3%–35.5%] versus 15.0% [14.3%–16.5%]) and anxiety (19.6% [17.6%–23.3%] versus 10.4% [9.8%–11.8%]). The prevalence of depression was 46% higher in the most deprived fifth of SES compared with the least deprived fifth (age/sex-standardised prevalence of 38.4% [31.2%–62.0%] versus 26.3% [23.1%–34.5%], respectively). This is a descriptive study of routine electronic health records in the UK, which might underestimate the true prevalence of diseases.ConclusionsThe burden of multimorbidity and comorbidity in patients with incident non-fatal CVD increased between 2000 and 2014. On average, older patients, women, and socioeconomically deprived groups had higher numbers of comorbidities, but the type of comorbidities varied by age and sex. Cardiometabolic conditions contributed substantially to the burden, but 4 out of the 10 top comorbidities were non-cardiometabolic. The current single-disease paradigm in CVD management needs to broaden and incorporate the large and increasing burden of comorbid...

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“…Major clinical guidelines recommend the inclusion of symptom monitoring as part of routine self-care management of patients with heart failure [10]. This can be challenging because symptom changes can be so insidious that patients have difficulty recognizing and responding to them, as well as differentiating them from symptoms of other chronic conditions including, depression [11], atrial fibrillation, diabetes, and chronic kidney disease [12]. Despite these difficulties, active participation in self-care management is crucial in heart failure because patients who are involved in their own care are more likely to have improved survival, decreased readmission rates, and better quality of life [13–15].…”

Section: Introductionmentioning

confidence: 99%

Gerontechnologies for Older Patients with Heart Failure: What is the Role of Smartphones, Tablets, and Remote Monitoring Devices in Improving Symptom Monitoring and Self-Care Management?

Creber

Hickey

Maurer

2016

Curr Cardiovasc Risk Rep

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Older adults with heart failure have multiple chronic conditions and a large number and range of symptoms. A fundamental component of heart failure self-care management is regular symptom monitoring. Symptom monitoring can be facilitated by cost-effective, easily accessible technologies that are integrated into patients’ lives. Technologies that are tailored to older adults by incorporating gerontological design principles are called gerontechnologies. Gerontechnology is an interdisciplinary academic and professional field that combines gerontology and technology with the goals of improving prevention, care, and enhancing the quality of life for older adults. The purpose of this article is to discuss the role of gerontechnologies, specifically the use of mobile applications available on smartphones and tablets as well as remote monitoring systems, for outpatient disease management among older adults with heart failure. While largely unproven, these rapidly developing technologies have great potential to improve outcomes among older persons.

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Multimorbidity in Older Patients with Cardiovascular Disease

Cited by 65 publications

References 54 publications

Prognosis of cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome

Prognosis of cardiovascular and non-cardiovascular multimorbidity after acute coronary syndrome

Patterns and temporal trends of comorbidity among adult patients with incident cardiovascular disease in the UK between 2000 and 2014: A population-based cohort study

Gerontechnologies for Older Patients with Heart Failure: What is the Role of Smartphones, Tablets, and Remote Monitoring Devices in Improving Symptom Monitoring and Self-Care Management?

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