Skip to main content

Advertisement

SpringerLink
Log in

Multimorbidity in Older Patients with Cardiovascular Disease

  • Elderly + Heart Disease (K. Dharmarajan, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Multimorbidity affects more than two thirds of older individuals and the vast majority of patients with chronic cardiovascular disease. Patients with multimorbidity have high resource utilization, poor mobility, and poor health status and are at an increased risk for death. The presence of multimorbidity imposes numerous management challenges in caring for patients with chronic cardiovascular disease. It complicates decision-making, promotes fragmented care, and imposes an immense burden on the patient and their social support system. Novel models of care, such as the cardiovascular patient-centered medical home, are needed to provide high-quality, efficient, effective care to this growing population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. U.S. Department of Health and Human Services HHS Initiative on Multiple Chronic Conditions; 2010. http://www.hhs.gov/ash/initiatives/mcc/#_edn3. Accessed July 19, 2015.

  2. Anderson G. Chronic care: making the case for ongoing care. 2010. Robert Wood Johnson Foundation, http://www.rwjf.org/en/library/research/2010/01/chronic-care.html. Accessed July 20, 2015.

  3. St Sauver JL, Boyd CM, Grossardt BR, Bobo WV, Finney Rutten LJ, Roger VL, et al. Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity. BMJ Open. 2015;5(2), e006413.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Salive ME. Multimorbidity in older adults. Epidemiol Rev. 2013;35:75–83.

    Article  PubMed  Google Scholar 

  5. Abad-Diez JM, Calderon-Larranaga A, Poncel-Falco A, Poblador-Plou B, Calderon-Meza JM, Sicras-Mainar A, et al. Age and gender differences in the prevalence and patterns of multimorbidity in the older population. BMC Geriatr. 2014;14:75.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Rocca WA, Boyd CM, Grossardt BR, Bobo WV, Finney Rutten LJ, Roger VL, et al. Prevalence of multimorbidity in a geographically defined American population: patterns by age, sex, and race/ethnicity. Mayo Clin Proc. 2014;89(10):1336–49. This article offers a comprehensive population-based report on the burden of multimorbidity in a community.

    Article  PubMed Central  PubMed  Google Scholar 

  7. van den Bussche H, Koller D, Kolonko T, Hansen H, Wegscheider K, Glaeske G, et al. Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health. 2011;11:101.

    Article  PubMed Central  PubMed  Google Scholar 

  8. van den Bussche H, Schon G, Kolonko T, Hansen H, Wegscheider K, Glaeske G, et al. Patterns of ambulatory medical care utilization in elderly patients with special reference to chronic diseases and multimorbidity—results from a claims data based observational study in Germany. BMC Geriatr. 2011;11:54.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chron Dis. 2014;11, E62.

    Google Scholar 

  10. Lochner KA, Cox CS. Prevalence of multiple chronic conditions among medicare beneficiaries, United States, 2010. Prev Chron Dis. 2013;10, E61.

    Google Scholar 

  11. Ashman JJ, Beresovsky V. Multiple chronic conditions among US adults who visited physician offices: data from the National Ambulatory Medical Care Survey, 2009. Prev Chron Dis. 2013;10, E64.

    Google Scholar 

  12. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43.

    Article  PubMed  Google Scholar 

  13. St John PD, Tyas SL, Menec V, Tate R. Multimorbidity, disability, and mortality in community-dwelling older adults. Can Fam Physician. 2014;60(5):e272–80.

    PubMed Central  PubMed  Google Scholar 

  14. Bahler C, Huber CA, Brungger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Serv Res. 2015;15:23. This study provides quantification of the substantial differences in healthcare utilization and costs in patients with multimorbidity compared to those without in a large elderly Swiss population.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Kirchberger I, Meisinger C, Heier M, Zimmermann AK, Thorand B, Autenrieth CS, et al. Patterns of multimorbidity in the aged population. Results from the KORA-Age study. PLoS One. 2012;7(1):e30556.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  16. Fabbri E, An Y, Zoli M, Simonsick EM, Guralnik JM, Bandinelli S, et al. Aging and the burden of multimorbidity: associations with inflammatory and anabolic hormonal biomarkers. J Gerontol A Biol Sci Med Sci. 2015;70(1):63–70.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Arnett DK, Goodman RA, Halperin JL, Anderson JL, Parekh AK, Zoghbi WA. AHA/ACC/HHS strategies to enhance application of clinical practice guidelines in patients with cardiovascular disease and comorbid conditions: from the American Heart Association, American College of Cardiology, and U.S. Department of Health and Human Services. J Am Coll Cardiol. 2014;64(17):1851–6. In addition to providing recommendations to address comorbidities in future clinical practice guidelines for patients with cardiovascular disease, this manuscript also provides important data on the prevalence of comorbidities in older patients with cardiovascular diseases including heart failure, ischemic heart disease, stroke and atrial fibrillation.

    Article  PubMed  Google Scholar 

  18. Prados-Torres A, Calderon-Larranaga A, Hancco-Saavedra J, Poblador-Plou B, van den Akker M. Multimorbidity patterns: a systematic review. J Clin Epidemiol. 2014;67(3):254–66.

    Article  PubMed  Google Scholar 

  19. Schafer I, von Leitner EC, Schon G, Koller D, Hansen H, Kolonko T, et al. Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS One. 2010;5(12), e15941.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  20. Newcomer SR, Steiner JF, Bayliss EA. Identifying subgroups of complex patients with cluster analysis. Am J Manag Care. 2011;17(8):e324–32.

    PubMed  Google Scholar 

  21. Marengoni A, Rizzuto D, Wang HX, Winblad B, Fratiglioni L. Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 2009;57(2):225–30.

    Article  PubMed  Google Scholar 

  22. Garcia-Olmos L, Salvador CH, Alberquilla A, Lora D, Carmona M, Garcia-Sagredo P, et al. Comorbidity patterns in patients with chronic diseases in general practice. PLoS One. 2012;7(2), e32141.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  23. Prados-Torres A, Poblador-Plou B, Calderon-Larranaga A, Gimeno-Feliu LA, Gonzalez-Rubio F, Poncel-Falco A, et al. Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis. PLoS One. 2012;7(2), e32190.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  24. Marengoni A, von Strauss E, Rizzuto D, Winblad B, Fratiglioni L. The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community-based, longitudinal study. J Intern Med. 2009;265(2):288–95.

    Article  PubMed  CAS  Google Scholar 

  25. Koroukian SM, Warner DF, Owusu C, Given CW. Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions. Prev Chron Dis. 2015;12, E55.

    Google Scholar 

  26. Tinetti ME, McAvay GJ, Murphy TE, Gross CP, Lin H, Allore HG. Contribution of individual diseases to death in older adults with multiple diseases. J Am Geriatr Soc. 2012;60(8):1448–56.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Di Angelantonio E, Kaptoge S, Wormser D, Willeit P, Butterworth AS, Bansal N, et al. Association of cardiometabolic multimorbidity with mortality. JAMA. 2015;314(1):52–60. This manuscript uses data from more than 269,000 patients in the Emerging Risk Factors Collaboration to provide estimates of the reductions in life expectancy associated with cardiometabolic multimorbidity.

    Article  PubMed  CAS  Google Scholar 

  28. Chen HY, Saczynski JS, McManus DD, Lessard D, Yarzebski J, Lapane KL, et al. The impact of cardiac and noncardiac comorbidities on the short-term outcomes of patients hospitalized with acute myocardial infarction: a population-based perspective. Clin Epidemiol. 2013;5:439–48.

    PubMed Central  PubMed  Google Scholar 

  29. McManus DD, Nguyen HL, Saczynski JS, Tisminetzky M, Bourell P, Goldberg RJ. Multiple cardiovascular comorbidities and acute myocardial infarction: temporal trends (1990–2007) and impact on death rates at 30 days and 1 year. Clin Epidemiol. 2012;4:115–23.

    PubMed Central  PubMed  Google Scholar 

  30. Saia F, Latib A, Ciuca C, Gasparetto V, Napodano M, Sticchi A, et al. Causes and timing of death during long-term follow-up after transcatheter aortic valve replacement. Am Heart J. 2014;168(5):798–806.

    Article  PubMed  Google Scholar 

  31. Oudejans I, Mosterd A, Zuithoff NP, Hoes AW. Comorbidity drives mortality in newly diagnosed heart failure: a study among geriatric outpatients. J Card Fail. 2012;18(1):47–52.

    Article  PubMed  Google Scholar 

  32. Condelius A, Edberg AK, Jakobsson U, Hallberg IR. Hospital admissions among people 65+ related to multimorbidity, municipal and outpatient care. Arch Gerontol Geriatr. 2008;46(1):41–55.

    Article  PubMed  Google Scholar 

  33. Starfield B, Lemke KW, Herbert R, Pavlovich WD, Anderson G. Comorbidity and the use of primary care and specialist care in the elderly. Ann Fam Med. 2005;3(3):215–22.

    Article  PubMed Central  PubMed  Google Scholar 

  34. van Oostrom SH, Picavet HS, de Bruin SR, Stirbu I, Korevaar JC, Schellevis FG, et al. Multimorbidity of chronic diseases and health care utilization in general practice. BMC Fam Pract. 2014;15:61.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Tinetti ME, McAvay GJ, Chang SS, Newman AB, Fitzpatrick AL, Fried TR, et al. Contribution of multiple chronic conditions to universal health outcomes. J Am Geriatr Soc. 2011;59(9):1686–91.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Chen HY, Baumgardner DJ, Rice JP. Health-related quality of life among adults with multiple chronic conditions in the United States, behavioral risk factor surveillance system, 2007. Prev Chron Dis. 2011;8:A09.

    Google Scholar 

  37. Uhlig K, Leff B, Kent D, Dy S, Brunnhuber K, Burgers JS, et al. A framework for crafting clinical practice guidelines that are relevant to the care and management of people with multimorbidity. J Gen Intern Med. 2014;29(4):670–9.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey Jr DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240–327.

    Article  PubMed  Google Scholar 

  39. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc 2012, 60(10):E1-E25. This guide provides practical, comprehensive tips for systematically approaching older patients with multimorbidity in clinical practice.

  40. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.

    Article  PubMed  CAS  Google Scholar 

  41. Bromfield SG, Bowling CB, Tanner RM, Peralta CA, Odden MC, Oparil S, et al. Trends in hypertension prevalence, awareness, treatment, and control among US adults 80 years and older, 1988–2010. J Clin Hypertens (Greenwich). 2014;16(4):270–6.

    Article  Google Scholar 

  42. Sim JJ, Shi J, Kovesdy CP, Kalantar-Zadeh K, Jacobsen SJ. Impact of achieved blood pressures on mortality risk and end-stage renal disease among a large, diverse hypertension population. J Am Coll Cardiol. 2014;64(6):588–97.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Ikeda Y, Shimada K, Teramoto T, Uchiyama S, Yamazaki T, Oikawa S, et al. Low-dose aspirin for primary prevention of cardiovascular events in Japanese patients 60 years or older with atherosclerotic risk factors: a randomized clinical trial. JAMA. 2014;312(23):2510–20.

    Article  PubMed  CAS  Google Scholar 

  44. Kutner JS, Blatchford PJ, Taylor Jr DH, Ritchie CS, Bull JH, Fairclough DL, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175(5):691–700.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Levin A, Chaudhry MR, Djurdjev O, Beaulieu M, Komenda P. Diabetes, kidney disease and cardiovascular disease patients. Assessing care of complex patients using outpatient testing and visits: additional metrics by which to evaluate health care system functioning. Nephrol Dial Transplant. 2009;24(9):2714–20.

    Article  PubMed  Google Scholar 

  46. Liu CW, Einstadter D, Cebul RD. Care fragmentation and emergency department use among complex patients with diabetes. Am J Manag Care. 2010;16(6):413–20.

    PubMed  CAS  Google Scholar 

  47. Jowsey T, Yen L, Mathews WP. Time spent on health related activities associated with chronic illness: a scoping literature review. BMC Public Health. 2012;12:1044.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Gill A, Kuluski K, Jaakkimainen L, Naganathan G, Upshur R, Wodchis WP. "Where do we go from here?" health system frustrations expressed by patients with multimorbidity, their caregivers and family physicians. Healthc Policy. 2014;9(4):73–89.

    PubMed  Google Scholar 

  49. Fried TR, Bradley EH, O'Leary JR, Byers AL. Unmet desire for caregiver-patient communication and increased caregiver burden. J Am Geriatr Soc. 2005;53(1):59–65.

    Article  PubMed  Google Scholar 

  50. Boult C, Wieland GD. Comprehensive primary care for older patients with multiple chronic conditions: "Nobody rushes you through". JAMA. 2010;304(17):1936–43.

    Article  PubMed  CAS  Google Scholar 

  51. Boyd CM, Boult C, Shadmi E, Leff B, Brager R, Dunbar L, et al. Guided care for multimorbid older adults. Gerontologist. 2007;47(5):697–704.

    Article  PubMed  Google Scholar 

  52. Boyd CM, Reider L, Frey K, Scharfstein D, Leff B, Wolff J, et al. The effects of guided care on the perceived quality of health care for multi-morbid older persons: 18-month outcomes from a cluster-randomized controlled trial. J Gen Intern Med. 2010;25(3):235–42.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Boult C, Reider L, Leff B, Frick KD, Boyd CM, Wolff JL, et al. The effect of guided care teams on the use of health services: results from a cluster-randomized controlled trial. Arch Intern Med. 2011;171(5):460–6.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Counsell SR, Callahan CM, Buttar AB, Clark DO, Frank KI. Geriatric resources for assessment and care of elders (GRACE): a new model of primary care for low-income seniors. J Am Geriatr Soc. 2006;54(7):1136–41.

    Article  PubMed  Google Scholar 

  55. Fields D, Leshen E, Patel K. Analysis & commentary. Driving quality gains and cost savings through adoption of medical homes. Health Aff. 2010;29(5):819–26.

    Article  Google Scholar 

  56. Beadles CA, Farley JF, Ellis AR, Lichstein JC, Morrissey JP, DuBard CA, et al. Do medical homes increase medication adherence for persons with multiple chronic conditions? Med Care. 2015;53(2):168–76.

    Article  PubMed  Google Scholar 

  57. Walsh MN, Bove AA, Cross RR, Ferdinand KC, Forman DE, Freeman AM, et al. ACCF 2012 health policy statement on patient-centered care in cardiovascular medicine: a report of the American College of Cardiology Foundation Clinical Quality Committee. J Am Coll Cardiol. 2012;59(23):2125–43. This article proposes and discusses the concept of the patient-centered medical home for cardiovascular care.

    Article  PubMed  Google Scholar 

  58. National Quality Forum: Multiple Chronic Conditions (MCC) Measurement Framework. http://www.qualityforum.org/Projects/Multiple_Chronic_Conditions_Measurement_Framework.aspx. Accessed August 21, 2015.

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Diseases, Department of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Shannon M. Dunlay

  2. Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Shannon M. Dunlay & Alanna M. Chamberlain

Authors
  1. Shannon M. Dunlay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alanna M. Chamberlain
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shannon M. Dunlay.

Ethics declarations

Conflict of Interest

Shannon Dunlay and Alanna Chamberlain have no disclosures to report.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Additional information

This article is part of the Topical Collection on Elderly + Heart Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dunlay, S.M., Chamberlain, A.M. Multimorbidity in Older Patients with Cardiovascular Disease. Curr Cardiovasc Risk Rep 10, 3 (2016). https://doi.org/10.1007/s12170-016-0491-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s12170-016-0491-8

Keywords

Search

Navigation