BOOK
Managing Chronic Conditions in Older Adults with Cardiovascular Disease, An Issue of Clinics in Geriatric Medicine, E-Book
Michael W. Rich | Cynthia Boyd | James T. Pacala
(2016)
Additional Information
Book Details
Abstract
This issue of Clinics in Geriatric Medicine, guest edited by Drs. Cynthia Boyd, James T. Pacala, and Michael W. Rich, is devoted to Chronic Conditions in Older Adults with Cardiovascular Disease. Articles in this issue include: Epidemiology of multimorbidity in older adults with cardiovascular disease; Impact of multimorbidity on clinical outcomes in older adults with cardiovascular disease; Assessment of goals of care in patients with multiple chronic conditions; Challenges in decision-making: balancing trade-offs; Multimorbidity in older adults with heart failure; Multimorbidity in older adults with acute coronary syndromes; Multimorbidity in older adults with aortic stenosis; Multimorbidity in older adults with atrial fibrillation;Anticoagulation in older adults with multimorbidity; Approach to evaluating the multimorbid patient with cardiovascular disease undergoing non-cardiac surgery; Integrating care across disciplines; Assessing risks and benefits of invasive cardiac procedures in patients with advanced multimorbidity; Multimorbidity and end of life care in patients with cardiovascular disease; and Future research directions for cardiovascular disease.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Managing ChronicConditions in Older Adultswith CardiovascularDisease | i | ||
| Copyright | ii | ||
| Contributors | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Preface: Working Together in the Care of Patients with Cardiovascular Disease and Multimorbidity | vii | ||
| Epidemiology of Multimorbidity in Older Adults with Cardiovascular Disease | vii | ||
| Magnitude and Impact of Multimorbidity on Clinical Outcomes in Older Adults with Cardiovascular Disease: A Literature Review | vii | ||
| Advance Care Planning and Goals of Care Communication in Older Adults with Cardiovascular Disease and Multi-Morbidity | vii | ||
| Patient Priority–Directed Decision Making and Care for Older Adults with Multiple Chronic Conditions | viii | ||
| Multimorbidity in Older Adults with Heart Failure | viii | ||
| Multiple Chronic Conditions in Older Adults with Acute Coronary Syndromes | viii | ||
| Multimorbidity in Older Adults with Aortic Stenosis | viii | ||
| Multimorbidity in Older Adults with Atrial Fibrillation | ix | ||
| Anticoagulation in Older Adults with Multimorbidity | ix | ||
| Approach to Evaluating the Multimorbid Patient with Cardiovascular Disease Undergoing Noncardiac Surgery | ix | ||
| Assessing Risks and Benefits of Invasive Cardiac Procedures in Patients with Advanced Multimorbidity | x | ||
| Integrating Care Across Disciplines | x | ||
| Multimorbidity and End of Life Care in Patients with Cardiovascular Disease | x | ||
| Future Research Directions for Multimorbidity Involving Cardiovascular Diseases | x | ||
| CLINICS IN GERIATRIC MEDICINE | xii | ||
| FORTHCOMING ISSUES | xii | ||
| August 2016 | xii | ||
| November 2016 | xii | ||
| February 2017 | xii | ||
| RECENT ISSUES | xii | ||
| February 2016 | xii | ||
| November 2015 | xii | ||
| August 2015 | xii | ||
| Preface:\rWorking Together in the Care of Patients with Cardiovascular Disease and Multimorbidity | xiii | ||
| Epidemiology of Multimorbidity in Older Adults with Cardiovascular Disease | 215 | ||
| Key points | 215 | ||
| INTRODUCTION | 215 | ||
| PREVALENCE OF MULTIMORBIDITY | 216 | ||
| MULTIMORBIDITY AND GERIATRIC SYNDROMES | 217 | ||
| Frailty | 218 | ||
| MULTIMORBIDITY AND CARDIOVASCULAR DISEASE | 218 | ||
| IMPACT OF MULTIMORBIDITY AND CARDIOVASCULAR DISEASE | 221 | ||
| SUMMARY | 224 | ||
| REFERENCES | 224 | ||
| Magnitude and Impact of Multimorbidity on Clinical Outcomes in Older Adults with Cardiovascular Disease | 227 | ||
| Key points | 227 | ||
| INTRODUCTION | 227 | ||
| METHODS | 228 | ||
| Search Strategy and Information Sources | 228 | ||
| RESULTS | 230 | ||
| Search Results | 230 | ||
| Study Characteristics | 231 | ||
| Assessment and Magnitude of Multimorbidity | 231 | ||
| Multimorbidity and Clinical Outcomes | 231 | ||
| DISCUSSION | 239 | ||
| SUMMARY | 244 | ||
| REFERENCES | 244 | ||
| MEDLINE SEARCH STRATEGY | 246 | ||
| Advance Care Planning and Goals of Care Communication in Older Adults with Cardiovascular Disease and Multi-Morbidity | 247 | ||
| Key points | 247 | ||
| INTRODUCTION | 248 | ||
| What Is Advance Care Planning? | 248 | ||
| Benefits of and Challenges to Advance Care Planning in Older Patients with Cardiovascular Disease and Multi-Morbidity | 250 | ||
| Challenges of advance care planning in older adults with cardiovascular disease | 250 | ||
| Patient and clinician barriers to advance care planning and goals of care communication | 250 | ||
| Practical Steps to Advance Care Planning in Older Adults with Cardiovascular Diseases | 251 | ||
| Assessing and addressing patients’ readiness and barriers to advance care planning | 252 | ||
| Identifying surrogate decision-makers | 252 | ||
| Asking about values related to quality of life | 252 | ||
| Translating patient values into specific medical treatment plans | 256 | ||
| Documenting patient preferences | 257 | ||
| Team-Based Approaches to Advance Care Planning | 257 | ||
| Patient-Centered Advance Care Planning Tools and Approaches to Goals of Care Conversations | 257 | ||
| SUMMARY | 258 | ||
| REFERENCES | 258 | ||
| Patient Priority–Directed Decision Making and Care for Older Adults with Multiple Chronic Conditions | 261 | ||
| Key points | 261 | ||
| THE PROBLEM | 262 | ||
| Care Is Fragmented and Lacking in Accountability | 262 | ||
| Care Is of Unclear Benefit and Potential Harm | 262 | ||
| Care Is Burdensome | 263 | ||
| Care May Not Focus on What Matters Most to Patients | 263 | ||
| THE SOLUTION | 263 | ||
| Development of Patient Priority–Directed Care | 263 | ||
| Identified Contributors | 263 | ||
| Patient Priority–Directed Care As An Approach to Improve Care and Outcomes of Older Adults with Multiple Chronic Conditions | 265 | ||
| For Whom Is Patient Priority–Directed Care Beneficial? | 265 | ||
| Guiding principles and core elements of patient priority–directed care | 266 | ||
| Challenges and opportunities | 267 | ||
| Patient Priority–Directed Care and Advanced Care Planning | 267 | ||
| Steps in Implementing Patient Priority–Directed Care | 267 | ||
| What Is Needed to Support Implementation of Patient Priority–Directed Care | 271 | ||
| Patient Priority–Directed Care for Mrs Smith | 272 | ||
| ACKNOWLEDGMENTS | 273 | ||
| REFERENCES | 273 | ||
| Multimorbidity in Older Adults with Heart Failure | 277 | ||
| Key points | 277 | ||
| INTRODUCTION | 278 | ||
| EPIDEMIOLOGY OF MULTIMORBIDITY IN HEART FAILURE | 278 | ||
| IMPACT OF MULTIMORBIDITY ON DIAGNOSIS AND MANAGEMENT OF HEART FAILURE | 279 | ||
| Diagnostic Challenges | 279 | ||
| Treatment Challenges | 280 | ||
| MANAGEMENT OF HEART FAILURE IN THE SETTING OF MULTIMORBIDITY | 282 | ||
| Focus on Universal Health Outcomes | 282 | ||
| Formally Assess Cognitive Function | 283 | ||
| Prioritize Nonpharmacologic Treatments | 283 | ||
| Minimize Treatment Burden | 283 | ||
| Enhance Care-Coordination | 284 | ||
| SUMMARY | 284 | ||
| REFERENCES | 284 | ||
| Multiple Chronic Conditions in Older Adults with Acute Coronary Syndromes | 291 | ||
| Key points | 291 | ||
| INTRODUCTION | 291 | ||
| CARDIOVASCULAR COMORBIDITIES IN ACUTE CORONARY SYNDROME POPULATIONS | 293 | ||
| Atrial Fibrillation | 293 | ||
| NONCARDIOVASCULAR COMORBIDITIES IN ACUTE CORONARY SYNDROME POPULATIONS | 294 | ||
| Chronic Kidney Disease | 294 | ||
| Cancer | 295 | ||
| Anemia | 295 | ||
| Chronic Lung Disease | 295 | ||
| Dementia and Depression | 295 | ||
| MULTIPLE CHRONIC CONDITIONS IN ACUTE CORONARY SYNDROME POPULATIONS | 296 | ||
| MULTIPLE CHRONIC CONDITIONS AND EVIDENCE-BASED MEDICINE | 297 | ||
| CLINICAL IMPLICATIONS | 297 | ||
| SUMMARY AND FUTURE PERSPECTIVE | 298 | ||
| REFERENCES | 298 | ||
| Multimorbidity in Older Adults with Aortic Stenosis | 305 | ||
| Key points | 305 | ||
| INTRODUCTION | 305 | ||
| GERIATRIC OR AGING-RELATED COMORBIDITIES | 307 | ||
| Frailty | 307 | ||
| Disability | 308 | ||
| Cognitive Impairment | 308 | ||
| MEDICAL COMORBIDITIES | 308 | ||
| Chronic Obstructive Pulmonary Disease | 308 | ||
| Pulmonary Hypertension | 309 | ||
| Chronic Kidney Disease | 309 | ||
| Chronic Liver Disease | 309 | ||
| Anemia | 309 | ||
| Diabetes Mellitus | 309 | ||
| Cardiac and Vascular Comorbidities | 310 | ||
| COMORBIDITIES AND THE EVALUATION AND TREATMENT OF AORTIC STENOSIS | 310 | ||
| SUMMARY | 311 | ||
| REFERENCES | 311 | ||
| Multimorbidity in Older Adults with Atrial Fibrillation | 315 | ||
| Key points | 315 | ||
| INTRODUCTION | 315 | ||
| EPIDEMIOLOGY OF ATRIAL FIBRILLATION AND MULTIMORBIDITY | 316 | ||
| TREATMENT OF ATRIAL FIBRILLATION | 318 | ||
| Rate Control Versus Rhythm Control | 318 | ||
| Tachy-brady syndrome | 322 | ||
| Rhythm Control | 322 | ||
| Prevention of Stroke and Systemic Embolization | 322 | ||
| COMMON COMORBID CONDITIONS AND GERIATRIC SYNDROMES | 323 | ||
| Heart Failure | 323 | ||
| Prior Stroke | 324 | ||
| Geriatric Syndromes | 325 | ||
| Cognitive impairment | 325 | ||
| Falls | 325 | ||
| Polypharmacy | 326 | ||
| Sensory impairment | 326 | ||
| Incontinence | 326 | ||
| EVIDENCE AND GUIDELINES | 326 | ||
| Shared Decision-Making | 326 | ||
| SUMMARY | 327 | ||
| REFERENCES | 327 | ||
| Anticoagulation in Older Adults with Multimorbidity | 331 | ||
| Key points | 331 | ||
| INTRODUCTION | 331 | ||
| MULTIMORBIDITY AND ATRIAL FIBRILLATION | 331 | ||
| STROKE PREVENTION IN MULTIMORBID ADULTS WITH ATRIAL FIBRILLATION | 332 | ||
| Assessing Stroke Risk | 332 | ||
| ANTICOAGULATION OPTIONS | 333 | ||
| Vitamin K Antagonists | 333 | ||
| Target-specific Oral Anticoagulants: Direct Thrombin Inhibitors and Factor Xa Inhibitors | 334 | ||
| Comparing Warfarin and Target-specific Oral Anticoagulants | 335 | ||
| SPECIAL CONSIDERATIONS IN PATIENTS WITH MULTIMORBIDITY | 337 | ||
| Net Clinical Benefit of Anticoagulation | 338 | ||
| Estimating Bleeding Risk of Anticoagulation | 339 | ||
| Fall Risk | 341 | ||
| Anticoagulants in the Setting of Polypharmacy | 341 | ||
| Quality of Life | 342 | ||
| Selecting the best anticoagulant for a patient with atrial fibrillation | 343 | ||
| SUMMARY | 343 | ||
| REFERENCES | 343 | ||
| Approach to Evaluating the Multimorbid Patient with Cardiovascular Disease Undergoing Noncardiac Surgery | 347 | ||
| Key points | 347 | ||
| COGNITION AND MOOD | 349 | ||
| PHYSICAL FUNCTION AND MOBILITY | 350 | ||
| SOCIAL SUPPORT | 350 | ||
| NUTRITIONAL STATUS | 351 | ||
| MEDICATION USE | 351 | ||
| PREOPERATIVE ORGAN SYSTEM ASSESSMENT | 352 | ||
| ” AND THE OLDER SURGICAL PATIENT | 352 | ||
| PREOPERATIVE OPTIMIZATION | 352 | ||
| SUMMARY | 354 | ||
| REFERENCES | 355 | ||
| Assessing Risks and Benefits of Invasive Cardiac Procedures in Patients with Advanced Multimorbidity | 359 | ||
| Key points | 359 | ||
| THE ALLURE OF SURGERY AND ITS LIMITATIONS IN THE CONTEXT OF MULTIMORBIDITY | 360 | ||
| MULTIMORBIDITY | 361 | ||
| MEDICAL COMPLEXITY AND PREOPERATIVE RISK ASSESSMENT | 362 | ||
| PERTINENT GERIATRIC PERSPECTIVES IN PREOPERATIVE ASSESSMENT | 364 | ||
| Multimorbidity | 364 | ||
| Frailty | 365 | ||
| Cognition | 365 | ||
| BEYOND THE PROCEDURE | 366 | ||
| Mobilization | 366 | ||
| Cardiac Rehabilitation | 366 | ||
| DECIDING IF A CARDIAC PROCEDURE IS WORTH THE RISK | 367 | ||
| SUMMARY | 368 | ||
| REFERENCES | 368 | ||
| Integrating Care Across Disciplines | 373 | ||
| Key points | 373 | ||
| INTRODUCTION | 373 | ||
| HISTORY OF INTERDISCIPLINARY CARE FOR OLDER ADULTS | 374 | ||
| GENERAL CHARACTERISTICS OF INTERDISCIPLINARY TEAMS | 375 | ||
| INTERDISCIPLINARY TEAM CARE IN CARDIOVASCULAR DISEASE | 375 | ||
| THE CASE OF HEART FAILURE | 378 | ||
| SUMMARY | 381 | ||
| REFERENCES | 381 | ||
| Multimorbidity and End of Life Care in Patients with Cardiovascular Disease | 385 | ||
| Key points | 385 | ||
| INTRODUCTION | 385 | ||
| CHALLENGES IN PROGNOSTICATION | 386 | ||
| PALLIATIVE CARE AND HOSPICE AT END OF LIFE | 387 | ||
| MULTIMORBIDITY AND NUANCES IN END OF LIFE CARE | 388 | ||
| Symptom Management | 388 | ||
| Inotropes | 389 | ||
| Withdrawal of Cardiac Medications and Device Therapies | 389 | ||
| EARLY AND ITERATIVE MULTIDISCIPLINARY CARE | 392 | ||
| SUMMARY | 393 | ||
| REFERENCES | 393 | ||
| Future Research Directions for Multimorbidity Involving Cardiovascular Diseases | 399 | ||
| Key points | 399 | ||
| INTRODUCTION | 399 | ||
| FRAMEWORK FOR MULTIMORBIDITY AND CARDIOVASCULAR DISEASES | 400 | ||
| BASIC SCIENCE AND DISCOVERY | 402 | ||
| CLINICAL TRIALS | 403 | ||
| PRACTICE-BASED RESEARCH | 403 | ||
| POPULATION-BASED RESEARCH | 404 | ||
| GUIDELINES | 405 | ||
| QUALITY MEASUREMENT | 405 | ||
| SUMMARY | 405 | ||
| REFERENCES | 406 | ||
| Index | 409 |