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Integrating Treatments for Atherosclerotic Cardiovascular Disease & Numerous Comorbidities

The challenges of caring for older adults with atherosclerotic cardiovascular disease and multiple chronic conditions is discussed in an Expert Consensus Decision Pathway from the American College of Cardiology:

“Atherosclerotic cardiovascular disease (ASCVD) is one of the most common chronic medical conditions worldwide. Most patients with ASCVD have other chronic conditions. Fractionated care plans, polypharmacy, side effects, drug–drug interactions, and financial toxicity can all begin to accumulate as patients acquire multimorbidity and advancing age. Clinicians caring for these patients need better guidance on how to mitigate ASCVD progression and major adverse cardiovascular events within the context of other chronic conditions, multiple guideline-directed medical therapies, changing prognoses, and patient preferences for care. Although this decision pathway is applicable to patients of all ages with ASCVD and multimorbidity, herein we advocate for the integration of evidence-based treatments into a broader value-based care framework that incorporates the American Geriatrics Society’s principles on the care of older adults with multimorbidity, the 4Ms from the Age-Friendly Health System, the 4-domain framework of care for older adults with heart failure, and social determinants of health. As patients acquire more chronic conditions, the burdens of available therapy intensify while life expectancy shortens. Accordingly, care for patients must shift from recommending all evidence-based options to an approach that prioritizes therapies with the greatest expected benefit/harm profile, while aligning with patients’ goals and preferences.”

Source: Journal of the American College of Cardiology