Patient-Centered Care of Older Adults with Cardiovascular Disease and Multiple Chronic Conditions

• Published in: Canadian journal of cardiology 2016-09, Vol.32 (9), p.1097-1107
• Main Authors: Kim, Dae Hyun, MD, MPH, ScD, Rich, Michael W., MD
• Format: Article
• Language: English
• Subjects: Aged; Algorithms; Cardiovascular; Cardiovascular Diseases - therapy; Decision Making; Drug Interactions; Geriatric Assessment; Humans; Multiple Chronic Conditions - therapy; Patient Compliance; Patient Preference; Patient-Centered Care; Prognosis
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2016.04.003

Abstract Multimorbidity, defined as the presence of 2 or more chronic conditions, is common among older adults with cardiovascular disease. These individuals are at increased risk for poor health outcomes and account for a large proportion of healthcare utilization. Clinicians are challenged with the heterogeneity of this population, the complexity of the treatment regimen, limited high-quality evidence, and fragmented healthcare systems. Each treatment recommended by a clinical practice guideline for a single cardiovascular disease may be rational, but the combination of all evidence-based recommendations can be impractical or even harmful to individuals with multimorbidity. These challenges can be overcome with a patient-centered approach that incorporates the individual’s preferences, relevant evidence, the overall and condition-specific prognosis, clinical feasibility of treatments, and interactions with other treatments and coexisting chronic conditions. The ultimate goal is to maximize benefits and minimize harms by optimizing adherence to the most essential treatments, while acknowledging trade-offs between treatments for different health conditions. It may be necessary to discontinue therapies that are not essential or potentially harmful to decrease the risk of drug-drug and drug-disease interactions from polypharmacy. A decision to initiate, withhold, or stop a treatment should be based on the time horizon to benefits vs. the individual’s prognosis. In this review, we illustrate how cardiologists and general practitioners can adopt a patient-centered approach to focus on the aspects of cardiovascular and non-cardiovascular health that have the greatest impact on functioning and quality of life in older adults with cardiovascular disease and multimorbidity.