2022 ACC ECDP on Integrating ASCVD and Multimorbidity Treatment: Key Points
- Birtcher KK, Allen LA, Anderson JL, et al.
- 2022 ACC Expert Consensus Decision Pathway for Integrating Atherosclerotic Cardiovascular Disease and Multimorbidity Treatment: A Framework for Pragmatic, Patient-Centered Care: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2022;Oct 25:[Epub ahead of print].
The following are key points to remember from this American College of Cardiology (ACC) Expert Consensus Decision Pathway (ECDP) on integrating atherosclerotic cardiovascular disease (ASCVD) and multimorbidity treatment:
- ASCVD is one of the most common chronic medical conditions worldwide and most patients with ASCVD have other chronic medical conditions. Although care of these patients is often siloed, these conditions can affect one another, with an experience of care that reflects the sum of one’s diseases. This ECDP applies to the patient with ASCVD and multimorbidity (i.e., multiple chronic conditions) in the outpatient setting.
- This EDCP endorses evidence-based secondary prevention and treatment approaches included in the ACC/American Heart Association (AHA) guidelines. However, the writing committee recognizes that stacking disease-specific clinical practice guidelines may lead to unintended consequences for the patient with ASCVD and multimorbidity. Following all possible recommendations applicable to an individual patient may not be practical or appropriate as chronic conditions multiply, life expectancy shortens, and prognosis worsens.
- Cardiovascular (CV) clinicians should consider the whole patient, not just CV conditions, when making treatment decisions. This includes life expectancy and other patient-specific domains (e.g., medical, mind and emotion, physical functioning, social and physical environment) when making treatment decisions.
- Clinicians should regularly review and reconcile all the patients’ medical conditions and treatment regimens to identify gaps in care.
- Optimal patient care is a continual process of medical decision making that prioritizes treatments that best promote the patient’s goals, priorities, and preferences as well as the medical knowledge of the clinician.
- High-value interventions should be pursued first. Expected benefits, potential harms, and burdens (e.g., polypharmacy) associated with initiating or changing therapy should be considered. Priority should often be given to treatments that address multiple clinical conditions at once.
- Deprescribing one or more medications or therapies may be the priority for some patients, especially as their clinical trajectory and health care goals change.
- Multidisciplinary team-based care should be used to address various treatment domains to attain the best possible outcomes for patients with ASCVD and multimorbidity. The treating clinician should seek input as needed from other relevant experts. The patient’s input is central to any treatment decisions and changes.
- Health systems and clinicians should leverage electronic health records to facilitate care coordination among clinicians, while promoting patient engagement.
- Health care organizations should advocate for legislative efforts to reward holistic, patient-centered care.
Keywords: Arteriosclerosis, Atherosclerosis, Carotid Artery Diseases, Coronary Disease, Decision Support Techniques, Decision Making, Shared, Deprescriptions, Diabetes Mellitus, Type 2, Electronic Health Records, Emotions, Evidence-Based Medicine, Guidelines as Topic, Health Care Costs, Heart Failure, Integrative Medicine, Multimorbidity, Multiple Chronic Conditions, Myocardial Ischemia, Obesity, Outpatients, Patient Care, Patient Care Planning, Patient Care Team, Patient-Centered Care, Polypharmacology, Polypharmacy, Practice Guidelines as Topic, Secondary Prevention, Vascular Diseases
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