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Week 1 of the PLOS Medicine Special Issue on Cardiovascular Disease and Multimorbidity

Senior Editor Amy Ross discusses the content published in week 1 of the PLOS Medicine Special Issue on CVD and Multimorbidity.

This week, publication of a Special Issue on Cardiovascular Disease (CVD) and Multimorbidity begins in PLOS Medicine, advised by Guest Editors Carolyn S. P. Lam, Duke-NUS Medical School, Singapore, Kazem Rahimi, The George Institute for Global Health, University of Oxford, UK, and Steven Steinhubl, Scripps Translational Science Institute, USA. The issue will feature research and discussion content related to multimorbidity in patients with CVD, the number one cause of death and disability globally.  In week 1, three research articles and one Health in Action article are publishing.

Using data from the UK Clinical Practice Research Datalink, a population-based dataset including routinely collected data from 674 UK general practices, Kazem Rahimi of the George Institute for Global Health, Oxford, UK, and colleagues describe the prevalence of 56 clinically important and common comorbidities in 229,205 patients with newly diagnosed non-fatal CVD between 2000 and 2014. Using age- and sex-standardized estimates, the researchers found that while the incidence of CVD decreased by 34% between 2000 to 2014, the prevalence of having 5 or more comorbidities increased from 6.3% (95% CI 5.6%±17.0%) in 2000 to 24.3% (22.1%±34.8%) in 2014. The most common comorbidities were hypertension (28.9%), depression (23.0%), arthritis, (20.9%), asthma (17.7%), and anxiety (15.0%). The researchers emphasize the need to broaden the current single-disease paradigm in CVD management to account for the increasing burden of comorbidities.

In a population-based study using data from the Myocardial Ischaemia National Audit Project (England and Wales), Marlous Hall of the University of Leeds, UK, and colleagues identified multimorbidity patterns in patients admitted with acute myocardial infarction (heart attack) between 2003 and 2013. Of the 693,388 patients with AMI admitted over this period, 60% had at least one of the 7 conditions examined (diabetes, chronic obstructive pulmonary disease or asthma, heart failure, renal failure, stroke, peripheral vascular disease, or hypertension). The researchers identified 3 multimorbidity phenotype clusters (high, medium, and low) and estimated that patients who had high and medium levels of multimorbidity had average reduced life expectancies of 2.9 (95% CI 2.6±3.2) and 1.5 years (95% CI 1.3±1.7), respectively, compared with patients who had few comorbidities. While the authors did not examine all common comorbid conditions (e.g. dementia and cancer), the findings provide support for developing guidelines for identification and treatment of comorbid conditions in patients with myocardial infarction.

Using data from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), Davide Vetrano of the Karolinska Institutet, Stockholm, Sweden, and colleagues examined trajectories of functional decline, measured by walking speed and activities of daily living (ADL), in 2,385 older adults with and without cardiovascular disease (e.g. ischemic heart disease, heart failure, and atrial fibrillation) and neuropsychiatric disease (e.g. mood disorders, dementia, and stroke).  During the 9-year follow-up, individuals with multiple cardiovascular and neuropsychiatric diseases had the steepest declines in walking speed (up to 0.7 m/s; p < 0.001) and ADL independence (up to three impairments in ADL) compared those without these diseases. The researchers observed significant declines over time for both walking speed and ADL in older adults with at 1 or more neuropsychiatric diseases, but only for walking speed and those with cardiovascular multimorbidity. While the authors were not able to account for the specific weight of single diseases, these findings suggest that neuropsychiatric diseases may play a greater role in functional decline in older adults than cardiovascular disease.

In a Health in Action article, Pragna Patel of the Centers for Disease Control and Prevention, Atlanta, USA, describe the development and implementation of a program designed to integrate hypertension management into HIV care in Malawi, where an estimated one-third of adults have hypertension. The researchers used a health systems strengthening approach and implemented the program into in two high volume HIV clinics in Malawi with standardized treatment protocols and patient registries to monitor treatment outcomes.  Between February 2015 and June 2016, 29,359 individuals were screened, 11% were newly diagnosed with hypertension, and 85% of those with hypertension received treatment per standardized protocols.

The issue will continue throughout March with new research and commentary papers each week—to view all the papers, visit the Special Issue Collection.

Feature image credit: Max Pixel

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