ACCF 2012 Health Policy Statement on Patient-Centered Care in Cardiovascular Medicine

Walsh, Mary Norine; Bové, Alfred A.; Cross, Russell R.; Ferdinand, Keith C.; Forman, Daniel E.; Freeman, Andrew M.; Hughes, Suzanne; Klodas, Elizabeth; Koplan, Michelle; Lewis, William R.; MacDonnell, Brian; May, David C.; Messer, Joseph V.; Pressler, Susan J.; Sanz, Mark L.; Spertus, John A.; Spinler, Sarah A.; Teichholz, Louis E.; Wong, John B.; Byrd, Katherine Doermann

doi:10.1016/j.jacc.2012.03.016

Cited by 61 publications

(24 citation statements)

References 152 publications

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“…Indeed, the American College of Cardiology has recently emphasized the consideration of psychosocial factors in practicing patient-centered care with these complex patients. 34 Moreover, prior studies suggest a complicated etiological relationship between the development of acute coronary events, multimorbidity, and psychosocial challenges. Many chronic diseases that are independent risk factors for an acute coronary syndrome may also cause stress, depression, anxiety, and functional decline.…”

Section: Discussionmentioning

confidence: 99%

Multiple Chronic Conditions and Psychosocial Limitations in Patients Hospitalized with an Acute Coronary Syndrome

Tisminetzky

Gurwitz

McManus

et al. 2016

The American Journal of Medicine

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Background As adults live longer, multiple chronic conditions have become more prevalent over the past several decades. We describe the prevalence of, and patient characteristics associated with, cardiac and non-cardiac-related multimorbidities in patients discharged from the hospital after an acute coronary syndrome. Methods We studied 2,174 patients discharged from the hospital after an acute coronary syndrome at 6 medical centers in Massachusetts and Georgia between April, 2011 and May, 2013. Hospital medical records yielded clinical information including presence of 8 cardiac-related and 8 non-cardiac-related morbidities on admission. We assessed multiple psychosocial characteristics during the index hospitalization using standardized in-person instruments. Results The mean age of the study sample was 61 years, 67% were men, and 81% were non-Hispanic whites. The most common cardiac-related morbidities were hypertension, hyperlipidemia, and diabetes (76%, 69%, and 31%, respectively). Arthritis, chronic pulmonary disease, and depression (20%, 18%, and 13%, respectively) were the most common non-cardiac morbidities. Patients with ≥4 morbidities (37% of the population) were slightly older and more frequently female than those with 0–1 morbidity; they were also heavier and more likely to be cognitively impaired (26% vs. 12%), have symptoms of moderate/severe depression (31% vs. 15%), high perceived stress (48% vs. 32%), a limited social network (22% vs. 15%), low health literacy (42% vs. 31%), and low health numeracy (54% vs. 42%). Conclusions Multimorbidity, highly prevalent in patients hospitalized with an acute coronary syndrome, is strongly associated with indices of psychosocial deprivation. This emphasizes the challenge of caring for these patients, which extends well beyond acute coronary syndrome management.

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Section: Discussionmentioning

confidence: 99%

Multiple Chronic Conditions and Psychosocial Limitations in Patients Hospitalized with an Acute Coronary Syndrome

Tisminetzky

Gurwitz

McManus

et al. 2016

The American Journal of Medicine

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“…The policy statement also discusses newer paradigms and challenges in patient-centered care, such as the impact of technology, complexity of care strategies with self-care, a systemic approach to episodic care, and barriers to patient-centered care. 35 …”

Section: Quality Of Carementioning

confidence: 99%

Heart Disease and Stroke Statistics—2014 Update

Go¹,

Mozaffarian²,

Roger³

et al. 2014

Circulation

4,327

2,343

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“…A meta-analysis from 20 studies and 376,162 patients examining usage of 7 drug classes that prevent cardiovascular disease reported average 2-year adherence rates of 50% for primary prevention and 66% for secondary prevention, with few differences between drug classes (60). Recent reports have emphasized the importance of patient-centered care and shared decision making, taking into account patient goals and preferences when choosing between therapies, especially when the prognosis of alternative approaches are roughly similar (61). Beyond considerations of whether revascularization reduces death and MI in SIHD, many patients favor the more immediate reduction in symptoms achievable with PCI and CABG, and avoidance of antianginal medications.…”

Section: The Case For Routine Revascularization In Patients With Sihdmentioning

confidence: 99%

Medical Therapy With Versus Without Revascularization in Stable Patients With Moderate and Severe Ischemia

Stone

Hochman

Williams

et al. 2016

Journal of the American College of Cardiology

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All patients with stable ischemic heart disease (SIHD) should be managed with guideline-directed medical therapy (GDMT), which reduces progression of atherosclerosis and prevents coronary thrombosis. Revascularization is also indicated in patients with SIHD and progressive or refractory symptoms, despite medical management. Whether a strategy of routine revascularization (with percutaneous coronary intervention or coronary artery bypass graft surgery as appropriate) plus GDMT reduces rates of death or myocardial infarction, or improves quality of life compared to an initial approach of GDMT alone in patients with substantial ischemia is uncertain. Opinions run strongly on both sides, and evidence may be used to support either approach. Careful review of the data demonstrates the limitations of our current knowledge, resulting in a state of community equipoise. The ongoing ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) is being performed to determine the optimal approach to managing patients with SIHD, moderate-to-severe ischemia, and symptoms that can be controlled medically.

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ACCF 2012 Health Policy Statement on Patient-Centered Care in Cardiovascular Medicine

Cited by 61 publications

References 152 publications

Multiple Chronic Conditions and Psychosocial Limitations in Patients Hospitalized with an Acute Coronary Syndrome

Multiple Chronic Conditions and Psychosocial Limitations in Patients Hospitalized with an Acute Coronary Syndrome

Heart Disease and Stroke Statistics—2014 Update

Medical Therapy With Versus Without Revascularization in Stable Patients With Moderate and Severe Ischemia

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