The American College of Cardiology (ACC) has published a new guidance document focused on the treatment of patients who present with atherosclerotic cardiovascular disease (ASCVD) and other chronic conditions such as hypertension, diabetes and atrial fibrillation (AFib).
The full expert consensus decision pathway (ECDP), written by a team of specialists, is available in full in the Journal of the American College of Cardiology.[1]
“ASCVD is one of the most common chronic medical conditions worldwide,” wrote Kim K. Birtcher, PharmD, MS, chair of the document’s writing group and an adjunct clinical professor with the University of Houston College of Pharmacy, and colleagues. “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. Unfortunately, fractionated communication, guideline stacking, polypharmacy, side effects, drug–drug interactions, pill burden, and financial toxicity tend to be more common as patients acquire multiple chronic conditions.”
Over the course of the document, Birtcher et al. shared several recommendations for cardiologists and other members of the heart team who see these patients on a daily basis.
They wrote, for example, that clinicians should remember to focus on the whole patient, not just their cardiovascular conditions, when making treatment decisions. Key details such as the patient’s life expectancy can play a crucial role when determining the best way to proceed.
The authors also emphasized that teamwork among physicians and other healthcare providers is crucial when treating patients who may be suffering from multiple chronic conditions.
“Team-based care should be used to address various treatment domains to attain the best possible outcomes for patients with ASCVD and multimorbidity,” they wrote, adding that clinicians should always be open to input from “other relevant experts.”
Prescribing the right medications
Another key topic included in the ECDP is that patients who present with ASCVD and other chronic conditions will often be eligible for many medications. Prescribing every single one of those medications to the same patient, without considering how they may react with one another, can do significant harm. Instead, a clinician should review how each of these medications might impact the short-term and long-term health of the patient, working to avoid adverse side effects or therapeutic confusion.
High-value interventions should be prioritized in these patients, Birtcher et al. wrote. Also, “priority should often be given to treatments that address multiple clinical conditions at once.”
The importance of electronic health records
The document’s authors noted that interconnected electronic health records (EHRs) are essential to treating these more challenging cardiovascular patients. If a patient has a history of AFib or heart failure, for instance, every primary care provider, specialist or nurse who speaks with them about their health should have that information readily available to them via an EHR.
Of course, EHRs are not the only way a patient’s health should be monitored over time.
“Because medication lists from the EHR are often inaccurate, patients should be encouraged to bring their medications or a complete list that includes the names, doses, and frequency to all appointments,” the authors wrote. “This is equally important for prescription medications, over-the-counter medications and supplements.”
Read the full document here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.