Epidemiology of Multimorbidity in Older Adults with Cardiovascular Disease

Abstract

Multimorbidity is the most significant condition affecting older adults, and it impacts every component of health care management and delivery. Multimorbidity significantly increases with age. For individuals with a diagnosis of cardiovascular disease, multimorbidity has a significant effect on the presentation of the disease and the diagnosis, management, and patient-centered preferences in care. Evidence-based therapeutics have focused on cardiovascular focused morbidity. Over the next 25 years, the proportion of adults aged 65 and older is estimated to increase three-fold. The needs of these patients require a fundamental shift in care from single disease practices to a more patient-centered framework.

Keywords: Cardiovascular disease; Chronic conditions; Multimorbidity; Older adults.

Figure 1

Percentage of Medicare Fee-for Service Beneficaries by Number of Multiple Chronic Conditions and Age (2010) showing increasing prevalence of multimorbidity with increasing age

Figure 2

Age and sex associated prevalence of multimorbidity by number of chronic conditions demonstrating the higher prevalence of number of chronic conditions above 65 as compared to below 65 and the higher prevalence of multimorbidity in women as compared to men.

Figure 3

Number of co-existing chronic conditions amongst Medicare Fee for Service Beneficiaries with common cardiovascular diagnoses

Figure 4

Conceptual model of comorbidity vs. multimorbidity in the context of CVD. A: Comorbid conceptual framework demonstrating the traditional disease-centered approach to understanding disease processes. Clinical practice guidelines are based on this framework where at most when comorbid conditions are considered they focus on disease pairs, such as CVD and diabetes mellitus or CVD and chronic kidney disease. B: Multimorbid conceptual framework demonstrating a more patient-centric approach to managing CVD in the context of multiple chronic conditions, geriatric syndromes, functional status and social determinants of health.

Figure 5

A: Readmission rates for Fee-for-Service Medicare beneficiaries by number of chronic conditions showing that readmission rates increase with increasing number of chronic conditions. B: Per Capita spending for Medicare beneficiaries by number of chronic conditions showing that individuals with 6 or more chronic conditions cost over 3 times the average spending rate.