Blog | Friday, September 12, 2014

QD: News Every Day--Cardiologists should consider comorbidities, study says


A quarter of adults in the U.S. have 2 or more chronic medical conditions, as do more than two-thirds of seniors, yet there are few clinical practice guidelines for cardiologists that take such comorbid conditions and their treatment into consideration. An put some numbers to how much comorbidity exists.

The authors of an article jointly developed by the American College of Cardiology, the American Heart Association, and the U.S. Department of Health and Human Services, reviewed Medicare claims for 2012 to determine the extent to which cardiovascular patients were filing claims for a range of other conditions such as pulmonary dysfunction, diabetes, arthritis and mental health disorders.

As was expected, hypertension and high cholesterol were the most common comorbidities for most of the major cardiovascular conditions. Notably, diabetes and arthritis were also very common in individuals with these conditions. For example, diabetes was a comorbidity in 41.7% of those with ischemic heart disease, 47.1% among heart failure patients, 37.1% in atrial fibrillation patients, and 41.5% in stroke patients. Arthritis was a comorbidity in 40.6% of those with ischemic heart disease, 45.6% among heart failure patients, 41.7% in atrial fibrillation patients, and 44.2% in stroke patients.

The analysis also revealed the presence of comorbidities such as chronic kidney disease, chronic obstructive pulmonary disease, Alzheimer’s disease/dementia, and depression among individuals with these cardiovascular conditions. For example, 26.3% of heart failure patients had Alzheimer’s disease/dementia, and 29.7% of stroke patients had depression.

The increase in so many comorbidities in aging patients with cardiovascular disease is an important clinical problem and makes developing new guidelines critical, the authors noted.

“We must try to better address many of the comorbidities that require special consideration,” said Jeffrey L. Anderson, MD, MACP, chair of the ACC/AHA Task Force on Practice Guidelines, and associate chief of cardiology at Intermountain Health Care, in Murray, Utah. “For example, arthritis is very common in older individuals who take analgesics that can make them more vulnerable to stomach bleeding, and blood thinners can cause serious consequences if stomach bleeding occurs, as can bladder complications.”

He said the ACC and AHA are working to provide cardiologists with a better understanding of how many drugs used to treat many conditions in older patients might react with current cardiovascular medications.

“Physicians often do not address these other conditions in making treatment decisions,” Dr. Anderson said. “This is intended as a wake-up call, since therapeutic decision making is getting more complicated because so many new drugs, devices, and therapeutic strategies for these other conditions are constantly coming into clinical practice. There is a lack of general awareness and even good clinical evidence available on possible interactions with cardiovascular and non-cardiovascular drugs.”