ACC Issues Guidance on Integrating ASCVD and Multimorbidity Care

The American College of Cardiology (ACC) has released an Expert Consensus Decision Pathway (ECDP) to provide guidance on treating and managing patients with atherosclerotic cardiovascular disease (ASCVD) and multiple chronic comorbidities.

ASCVD is one of the most common chronic medical conditions worldwide, and most patients with ASCVD have other chronic conditions. Yet, most clinical practice guidelines address a single medical condition and do not provide sufficient guidance for patients with multimorbidity, writing group chair Kim Birtcher, PharmD, University of Houston College of Pharmacy, Houston, Texas, told | Medscape Cardiology.

She noted that “stacking” disease-specific clinical practice guidelines may lead to unintended consequences for patients with ASCVD and multimorbidity, including polypharmacy, side effects, drug-drug interactions, and financial toxicity.

And following all possible recommendations may not be practical or appropriate as the number of chronic conditions increases, life expectancy shortens, and/or prognosis worsens, she added.

Care Optimization

During a recent ACC roundtable, clinicians and stakeholders from patient advocacy groups, health plans, drug manufacturers, and health systems discussed the real-world challenges of managing patients with ASCVD and multimorbidity.

Participants identified the need for expert consensus guidance on how to mitigate ASCVD progression and major CV events within the context of other chronic conditions, multiple guideline-directed medical therapies, changing prognoses, and patient preferences for care.

The ECDP developed by Birtcher and colleagues was published online October 25 in the Journal of the American College of Cardiology.

It provides a comprehensive and integrative approach for treating patients with ASCVD and multimorbidity based on the patient’s phase of life, with emphasis on a value-based framework that encourages prioritizing therapy tailored within a four-domain framework: medical, mind and emotion, physical functioning, social and physical environment.

“This approach provides clinicians and other members of the care team with a multidimensional understanding of the patient to better promote care optimization,” Birtcher told | Medscape Cardiology.

“Importantly, patients’ goals, priorities, and preferences should be included when making treatment decisions. The ECDP provides tools to facilitate incorporating the patient-specific domain assessment and what matters most to the patient into care decisions,” Birtcher said.

She encourages clinicians to regularly review and reconcile all the patient’s medical conditions and treatments to identify gaps in care and opportunities to prioritize high-value interventions.

“Deprescribing one or more medications or therapies may be the best option for some patients, especially as their clinical trajectory and healthcare goals change,” Birtcher said.

“Health systems should promote a team-based approach and also leverage interconnected electronic health records to facilitate implementation of the domain framework, the patient’s goals, priorities, and preferences, and easy access to the ECDP’s tools within the medical record,” she said.

Health systems should also formally evaluate the impact of implementing the domain framework and the tools from this ECDP on patients, clinicians, and the health system itself. Finally, professional organizations should advocate for legislative efforts to reward holistic, patient-centered care, Birtcher said.

Birtcher has disclosed no relevant financial relationships.

J Am Coll Cardiol. Published online October 25, 2022. Full text

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