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Multimorbidity: The complexity
Published in Bernadette N. Kumar, Esperanza Diaz, Migrant Health, 2019
Amaia Calderón-Larrañaga, Luis Andrés Gimeno-Feliu
Chronic conditions are one of the main current and future challenges to health systems worldwide. This chronic disease epidemic has enforced a paradigm shift in health care systems. Having more than one chronic disease concurrently, known as multimorbidity, adds still another layer of complexity to the management of patients with chronic diseases, especially at the primary care level, where this type of patient is more the rule than the exception (1).
General principles on caring for older adults
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
More than two thirds of older adults have two or more chronic conditions, or multimorbidity (10). Individuals with multimorbidity are at increased risk for death, disability, hospitalization, nursing facility stay, and health care utilization. The prevalence of multimorbidity increases with age; over 80% of people 85 years and older have at least two conditions and approximately 50% have at least four conditions. The most common pattern of multimorbidity is coexistence of cardio-metabolic disease and osteoarthritis (11). More than 50% of older individuals with heart failure, stroke, and atrial fibrillation have five or more chronic conditions (12). Common noncardiovascular conditions in those with CVD are arthritis, anemia, chronic kidney disease, cataracts, chronic obstructive pulmonary disease, dementia, and depression (12), which add to the complexity of CVD management in older adults. These non-cardiovascular conditions account for almost half of readmissions after an index admission for heart failure or myocardial infarction (13). Moreover, older adults with multimorbidity are frequently excluded from clinical trials of cardiovascular therapy. Therefore, it remains unclear whether clinical trial evidence on the benefits and risks can be generalized to patients with multimorbidity. Some evidence suggests that those with certain multimorbidity patterns may benefit less from guideline-recommended therapy (14).
Challenges
Published in Graham C. M. Watt, The Exceptional Potential of General Practice, 2018
More demanding definitions of multimorbidity – such as five or more conditions, the combination of a physical and psychological health problem, or three or more chronic conditions from different body systems – have lesser prevalences, but steeper social gradients, and present a significantly greater clinical challenge (2,3).
Impact of multimorbidity patterns in hospital admissions: the case study of asthma
Published in Journal of Asthma, 2023
Diana Portela, Pedro Pereira Rodrigues, Alberto Freitas, Elísio Costa, Jean Bousquet, João Almeida Fonseca, Bernardo Sousa Pinto
Multimorbidity is defined as the co-occurrence of two or more chronic health conditions within one person having a relevant burden on clinical and economic outcomes.(1–5) Current literature has assessed the burden of multimorbidity patterns on specific diseases such as chronic obstructive pulmonary disease (COPD), motor neuron disease or asthma.(5–8) Regarding the latter, multimorbidity has been studied mainly related to the presence of other allergic diseases.(5) This may be insufficient since the presence of non-allergic comorbidities alongside asthma may also be related to a poorer prognosis or to a worse impact of asthma episodes.(9–11) For example, a recent study emphasized the incremental costs for comorbidities associated with asthma and highlighted that treating associated diseases alongside asthma associated with improved asthma outcomes and overall health.(12) However, that study only defined multimorbidity based on the count of chronic diseases and did not consider their nature or how their patterns or combinations may impact the outcomes. In addition, we do not know the impact of asthma as a comorbidity on hospital admissions due to other conditions.(12) This is particularly relevant not only because of the high prevalence of asthma but also because individuals with asthma are more susceptible to infections and non-communicable chronic comorbidities which are associated with worse health outcomes.(10,11)
Cardiometabolic multimorbidity is common among patients with psoriasis and is associated with poorer outcomes compared to those without comorbidity
Published in Journal of Dermatological Treatment, 2022
Clinton W. Enos, Vanessa L. Ramos, Robert R. McLean, Tin-Chi Lin, Nicole Foster, Blessing Dube, Abby S. Van Voorhees
Yet, literature on the management of multimorbidity is limited, and often focuses on the complexity of coordinating care for patients with multidisciplinary efforts (10). Radner et al. assessed how the presence of multimorbidity might impact treatment response in patients with rheumatic disease. Their prospective study revealed 28% decreased odds of achieving remission at one year following initiation of a biologic or synthetic disease-modifying antirheumatic drug when multimorbidity was present (11). While this study provides insight into the general concept that increased comorbid disease burden associates with poorer therapeutic response, the study did not stratify by therapeutic class. Understanding how multimorbidity may impact specific therapies in achieving treatment outcomes among patients with inflammatory disease could be useful in personalizing care.
Multimorbidity of overweight and obesity alongside anxiety and depressive disorders in individuals with spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2021
Scott Graupensperger, Shane N. Sweet, M. Blair Evans
Weight gain and mental health disorders are both risks for SCI patients that occur in a similar timeline (i.e. after acquiring injury) and emerge through similar underlying causes such as physical inactivity. Indeed, multimorbidity is associated with a range of adverse outcomes that extend beyond the complications of the individual diagnoses.16,38 For example, as individuals with SCI develop secondary health conditions such as gaining excessive weight, their health care utilization dramatically increases and caretaking needs may become increasingly difficult (e.g. bathing and dressing), which contribute to decreased quality of life.38,39 Similar work outside of SCI has found that those who live with multimorbid chronic conditions have decreased quality of life and increased mortality compared to those with one condition or the other.40,41 Although there is early evidence that overweight/obese individuals with physical disabilities self-report lower levels of subjective well-being and health-related quality of life,11–43 there remains a critical gap in knowledge of whether overweight/obesity co-occurs alongside psychological disorders with greater prevalence in individuals with SCI than able-bodied individuals.