Impact of Multimorbidity on Clinical Outcomes in Older Adults With Cardiovascular Disease: A Literature Review
multimorbidity, cardiovascular disease
Background/Aims: We aimed to synthesize the current literature on the magnitude and impact of multiple chronic conditions on clinical outcomes, including total in-hospital and postdischarge mortality and hospitalizations, in older patients with cardiovascular disease.
Methods: A systematic review was conducted. Four electronic databases and article bibliographies were searched for publications from 2005 to 2015 that assessed the impact of multimorbidity on clinical outcomes in the elderly with cardiovascular disease. Identified studies were screened using predefined criteria for eligibility.
Results: Fifteen studies met our inclusion criteria. Multimorbidity was assessed by simply counting morbidities and/or by the Charlson and Elixhauser indices. Most the studies reported a significant association between number of morbidities or selected morbidities and the risk of dying; the most frequent conditions examined were diabetes, chronic kidney disease, anemia, chronic pulmonary disease and dementia/cognitive impairment.
Conclusion: There are limited data available on the magnitude and impact of multiple chronic conditions on clinical outcomes, including hospitalization and short- and long-term mortality, in patients with cardiovascular disease, and essentially no data on universal health outcomes (i.e. health-related quality of life, symptom burden and function). There is also a lack of consistency in the manner in which the burden of multimorbidity is assessed and characterized. Very few studies have addressed the true complexity of older patients with cardiovascular disease; how best to characterize multimorbidity in these patients and to relate this to clinical outcomes remains a substantial challenge.
Tisminetzky M, Goldberg R, Gurwitz JH. Impact of multimorbidity on clinical outcomes in older adults with cardiovascular disease: a literature review. J Patient Cent Res Rev. 2016;3:170.