Author + information
- Received August 30, 2017
- Revision received February 26, 2018
- Accepted March 1, 2018
- Published online May 7, 2018.
- Daniel E. Forman, MDa,∗ (, )
- Mathew S. Maurer, MDb,
- Cynthia Boyd, MD, MPHc,
- Ralph Brindis, MD, MPHd,
- Marcel E. Salive, MDe,
- Frances McFarland Horne, PhDf,
- Susan P. Bell, MBBS, MSCIg,
- Terry Fulmer, PhD, RNh,
- David B. Reuben, MDi,
- Susan Zieman, MDe and
- Michael W. Rich, MDj
- aDepartment of Medicine, Section of Geriatric Cardiology, Veterans Affairs Geriatric Research Education, and Clinical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
- bDepartment of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
- cDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- dPhillip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, California
- eDivision of Geriatrics and Clinical Gerontology, National Institute on Aging, Bethesda, Maryland
- fAssociation of Specialty Professors, Alexandria, Virginia
- gDivision of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- hJohn A. Hartford Foundation, New York, New York
- iDivision of Geriatrics, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
- jDivision of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- ↵∗Address for correspondence:
Dr. Daniel E. Forman, Section of Geriatric Cardiology, University of Pittsburgh, 3471 Fifth Avenue, Suite 500, Pittsburgh, Pennsylvania 15213.
Multimorbidity occurs in adults of all ages, but the number and complexity of comorbid conditions commonly increase with advancing age such that cardiovascular disease (CVD) in older adults typically occurs in a context of multimorbidity. Current clinical practice and research mainly target single disease-specific care that does not embrace the complexities imposed by concurrent conditions. In this paper, emerging concepts regarding CVD in combination with multimorbidity are reviewed, including recommendations for incorporating multimorbidity into clinical decision making, critical knowledge gaps, and research priorities to optimize care of complex older patients.
Supported in part by National Institute on Aging (NIA) grant U13AG047008, American Geriatrics Society, Edwards Lifesciences, Novartis Pharmaceuticals, Pfizer, and St. Jude Medical. Dr. Forman is supported by NIA grants P30 AG024827, NIA R56AG051637-01A1, VA RR and D F0834-R, and PCORI IH-13046787. Dr. Maurer is supported by NIA grant K24AG036778; receives funding for research and serves on the advisory boards and Data and Safety Monitoring Boards for Pfizer Inc., Alnylam Pharmaceuticals Inc., GSK Inc., ISIS Pharmaceuticals, Eidos Inc., and Prothena Inc. Dr. Boyd receives royalties from UpToDate Co. Dr. Fulmer is President of the John A. Hartford Foundation. The views expressed in written workshop materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services or its represented agencies; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 30, 2017.
- Revision received February 26, 2018.
- Accepted March 1, 2018.
- 2018 American College of Cardiology Foundation
- Central Illustration
- Defining Multimorbidity
- Pathophysiology and Implications of Multimorbidity: Intersections With CVD
- Concordant and Discordant Conditions
- Limitations of the Current CVD Therapeutic Paradigm to Address Multimorbidity
- A Multidimensional Approach to Multimorbidity
- Changing the Clinical Approach to Better Respond to Multimorbidity
- Knowledge Gaps and Research Priorities
- Clinical Guidelines
- Quality Metrics and Performance Measures
- Government Organizations
- Tools and Resources to Address Research Needs
- Integration into Clinical Practice
- Conclusions and Future Directions