Статья
Коморбидность и полиморбидность -современная трактовка и насущные задачи, стоящие перед терапевтическим сообществом
В статье представлен обзор данных, касающихся полиморбидности. Показано, что полиморбидность связана с более высокими показателями смертности, инвалидности, с побочными эффектами лечения, с повышенным использованием ресурсов системы здравоохранения, а также с более низким качеством жизни. Обсуждаются вопросы эффективного лечения людей с множественными хроническими заболеваниями. Обоснованы необходимость клинических исследований, включающих больных с множественными хроническими заболеваниями, и разработка новых клинических рекомендаций, на которые могли бы опираться практические врачи при лечении полиморбидных пациентов.
1. Fabbri E., Zoli M., Gonzalez-Freire M., Salive ME, Studenski SA, Ferrucci L. Aging and Multimorbidity: New Tasks, Priorities, and Frontiers for Integrated Gerontological and Clinical Research. Journal of the American Medical Directors Association. 2015,16 (8):640-7. DOI: 10.1016/j.jamda. 2015.03.013
2. Buffel du Vaure C., Ravaud P., Baron G., Barnes C., Gilberg S., Boutron I. Potential workload in applying clinical practice guidelines for patients with chronic conditions and multimorbidity: a systematic analysis. BMJ Open. 2016,6 (3):e010119. DOI:10.1136/bmjopen-2015-010119
3. Violan C., Foguet-Boreu Q., Flores-Mateo G., Salisbury C., Blom J., Freitag M. et al. Prevalence, Determinants and Patterns of Multimorbidity in Primary Care: A Systematic Review of Observational Studies. Scuteri A., редактор. PLoS ONE. 2014,9 (7):e102149. DOI:10.1371/journal. pone. 0102149
4. Turner A., Mulla A., Booth A., Aldridge S., Stevens S., Battye F. et al. An evidence synthesis of the international knowledge base for new care models to inform and mobilise knowledge for multispecialty community providers (MCPs). Systematic Reviews. 2016,5 (1). DOI: 10.1186/s13643-016-0346-x
5. Marengoni A., Winblad B., Karp A., Fratiglioni L. Prevalence of Chronic Diseases and Multimorbidity Among the Elderly Population in Sweden. American Journal of Public Health. 2008,98 (7):1198-200. DOI: 10.2105/AJPH. 2007.121137
6. Van Oostrom SH, Picavet HSJ, van Gelder BM, Lemmens LC, Hoeymans N., van Dijk CE et al. Multimorbidity and comorbidity in the Dutch population - data from general practices. BMC Public Health. 2012,12 (1). DOI:10.1186/1471-2458-12-715
7. Marengoni A., Angleman S., Melis R., Mangialasche F., Karp A., Garmen A. et al. Aging with multimorbidity: A systematic review ofthe literature. Ageing Research Reviews. 2011,10 (4):430-9. DOI:10.1016/j. arr. 2011.03.003
8. Nagel G., Peter R., Braig S., Hermann S., Rohrmann S., Linseisen J. The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort. BMC Public Health. 2008,8 (1). DOI:10.1186/1471-2458-8-384
9. Booth HP, Prevost AT, Gulliford M.C. Impact of body mass index on prevalence of multimorbidity in primary care: cohort study. Family Practice. 2014,31 (1):38-43. DOI:10.1093/fampra/cmt061
10. National Guideline Centre (UK). Multimorbidity: Assessment, Prioritisation and Management of Care for People with Commonly Occurring Multimorbidity. -London: National Institute for Health and Care Excellence (UK), 2016. PMID:27683922
11. Fortin M., Haggerty J., Almirall J., Bouhali T., Sasseville M., Lemieux M. Lifestyle factors and multimorbidity: a cross sectional study. BMC Public Health. 2014, 14 (1). DOI:10.1186/1471-2458-14-686
12. Feinstein A.R. The pretherapeutic classification of comorbidity in chronic disease.J. Chronic Dis. 1970,23 (7):455-68. PMID:26309916
13. Prados-Torres A., Calderon-Larranaga A., Hancco-Saavedra J., Poblador-Plou B., van den Akker M. Multimorbidity patterns: a systematic review. Journal of Clinical Epidemiology. 2014,67 (3):254-66. DOI: 10.1016/j.jclinepi. 2013.09.021
14. van den Akker M., Buntinx F., Metsemakers JFM, Roos S., Knottnerus J.A. Multimorbidity in General Practice: Prevalence, Incidence, and Determinants of Co-Occurring Chronic and Recurrent Diseases. Journal of Clinical Epidemiology. 1998,51 (5):367-75. DOI: 10.1016/S0895-4356 (97) 00306-5
15. Vogeli C., Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB et al. Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs. Journal of General Internal Medicine. 2007,22 (S3):391-5. DOI:10.1007/s11606-007-0322-1
16. Guettier J-M, Georgopoulos A., Tsai MY, Radha V., Shanthirani S., Deepa R. et al. Polymorphisms in the Fatty Acid-Binding Protein 2 and Apolipoprotein C-III Genes Are Associated with the Metabolic Syndrome and Dyslipidemia in a South Indian Population. The Journal of Clinical Endocrinology & Metabolism. 2005,90 (3):1705-11. DOI:10.1210/jc. 2004-1338
17. Barnes P.J. Cellular and Molecular Mechanisms of Chronic Obstructive Pulmonary Disease. Clinics in Chest Medicine. 2014,35 (1):71-86. DOI:10.1016/j. ccm. 2013.10.004
18. Comer DM, Kidney JC, Ennis M., Elborn J.S. Airway epithelial cell apoptosis and inflammation in COPD, smokers and nonsmokers. European Respiratory Journal. 2013,41 (5):1058-67. DOI:10.1183/09031936.00063112
19. Houghton A.M. Mechanistic links between COPD and lung cancer. Nature Reviews Cancer. 2013,13 (4):233-45. DOI:10.1038/nrc3477
20. Inoue D., Watanabe R., Okazaki R. COPD and osteoporosis: links, risks, and treatment challenges. International Journal of Chronic Obstructive Pulmonary Disease. 2016,637. DOI:10.2147/COPD. S79638
21. Savransky V., Nanayakkara A., Li J., Bevans S., Smith PL, Rodriguez A. et al. Chronic Intermittent Hypoxia Induces Atherosclerosis. American Journal of Respiratory and Critical Care Medicine. 2007,175 (12): 1290-7. DOI: 10.1164/rccm. 200612-1771OC
22. Gaddam S., Gunukula SK, Lohr JW, Arora P. Prevalence of chronic kidney disease in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. BMC Pulmonary Medicine. 2016,16 (1). DOI:10.1186/s12890-016-0315-0
23. Niven R. Chapter-08 Comorbidity in Refractory Asthma. Clinical Focus Series: Difficult Asthma. 1/e. NULL, 2013. с. 102-19. ISBN: 978-93-5090-299-8
24. Denham A. Clinical Decision-Making for Older Patients With Multiple Chronic Conditions: A Case-Based Exercise for Medical Students. MedEdPORTAL Publications. 2016, 12. DOI:10.15766/mep_2374-8265.10477
25. Tellez-Zenteno JF, Matijevic S., Wiebe S. Somatic Comorbidity ofEpilepsy in the General Population in Canada. Epilepsia. 2005,46 (12):1955-62. DOI:10.1111/j. 1528-1167.2005.00344. x
26. Nunes BP, Flores TR, Mielke GI, Thumé E., Facchini LA. Multimorbidity and mortality in older adults: A systematic review and metaanalysis. Archives of Gerontology and Geriatrics. 2016,67:130-8. DOI:10.1016/j. archger. 2016.07.008
27. Чесникова А. И., Батюшин М. М., Терентьев В. П. Артериальная гипертензия и коморбидность: современное состояние проблемы. Артериальная гипертензия. 2016,22(5):432-40. DOI: 10.18705 / 1607-419X-2016-22-5-432-440
28. Boyd CM, Fortin M. Future ofMultimorbidity Research: How Should Understanding ofMultimorbidity Inform Health System Design? Public Health Reviews. 2010,32 (2):451-74. DOI:10.1007/BF03391611
29. Арутюнов А. Г., Драгунов Д. О., Арутюнов Г. П., Рылова А. К., Пашкевич Д. Д., Витер К. В. и др. Первое открытое исследование синдрома острой декомпенсации СН и сопутствующих заболеваний в Российской Федерации. Независимый регистр ОРАКУЛ-РФ. Кардиология. 2015,55 (5):12-21. DOI:10.18565/cardio. 2015.5.12-21
30. Симонова Ж. Г., Мартусевич А. К., Тарловская Е. И. Клинико-патогенетические аспекты течения ИБС в сочетании с язвенной болезнью. Терапевтический Архив. 2014,86 ( 1):33-6.
31. Saseen JJ, Agashivala N, Allen RR, Ghushchyan V Yadao AM, Nair KV. Comparison of patient characteristics and gout-related health-care resource utilization and costs in patients with frequent versus infrequent gouty arthritis attacks. Rheumatology. 2012,51 (11):2004-12. DOI: 10.1093/rheumatology/kes 183
32. Сапожникова И. Е., Тарловская Е. И., Тарловский А. К. Варианты ремоделирования миокарда ЛЖ у пациентов с артериальной гипертензией и нарушениями углеводного обмена. Кардиология. 2013,53 (8):44-8.
33. Greenfield S. ComorbidityAffects the Relationship Between Glycemic Control and Cardiovascular Outcomes in Diabetes: A Cohort Study. Annals of Internal Medicine. 2009,151 (12):854. DOI:10.7326/000 3-4819-151-12-200912150-00005
34. Balandina Y., Simonova Z., Tarlovskaya Y. Comparison of combined therapy of cad accompanied by gastroduodenal pathology. Atherosclerosis. 2016,252: e17. DOI:10.1016/j. atherosclerosis. 2016.07.286
35. Clinical Practice Guidelines for Older Patients With Comorbid Diseases. JAMA. 2006,295 (1):33. DOI:10.1001/jama. 295.1.33-a
36. Dumbreck S., Flynn A., Nairn M., Wilson M., Treweek S., Mercer SW et al. Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines. BMJ. 2015,350 (mar112):h949 - h949. DOI:10.1136/bmj. h949
37. Fitzgerald SP, Bean N.G. An Analysis of the Interactions Between Individual Comorbidities and Their Treatments - Implications for Guidelines and Polypharmacy.Journal of the American Medical Directors Association. 2010,11 (7):475-84. DOI:10.1016/j. jamda. 2010.05.008
38. Rochon PA, Gurwitz J.H. Optimising drug treatment for elderly people: the prescribing cascade. BMJ. 1997,315 (7115):1096-9. PMID:9366745
39. Lorgunpai SJ, Grammas M., Lee DSH, McAvay G., Charpentier P., Tinetti M.E. Potential Therapeutic Competition in Community-Living Older Adults in the U. S.: Use of Medications That May Adversely Affect a Coexisting Condition. Quinn TJ, редактор. PLoS ONE. 2014,9 (2):e89447. DOI:10.1371/journal. pone. 0089447
40. Graham D.J. COX-2 Inhibitors, Other NSAIDs, and Cardiovascular Risk: The Seduction of Common Sense. JAMA. 2006,296 (13):1653. DOI: 10.1001/jama. 296.13. jed60058
41. Nissen SE, Wolski K. Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes. New England Journal of Medicine. 2007,356 (24):2457-71. DOI:10.1056/NEJ-Moa072761
42. Winkelmayer WC, Setoguchi S., Levin R., Solomon D.H. Comparison of Cardiovascular Outcomes in Elderly Patients With Diabetes Who Initiated Rosiglitazone vs Pioglitazone Therapy. Archives of Internal Medicine. 2008,168 (21):2368. DOI:10.1001/archinte. 168.21.2368
43. McPhail S., Schippers M., Marshall A. Age, physical inactivity, obesity, health conditions, and health-related quality of life among patients receiving conservative management for musculoskeletal disorders. Clinical Interventions in Aging. 2014,1069. DOI:10.2147/CIA. S61732
44. Beers MH. Explicit Criteria for Determining Potentially Inappropriate Medication Use by the Elderly: An Update. Archives of Internal Medicine. 1997,157 ( 14): 1531. DOI:10.1001/archinte. 1997.00440350031003
45. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Patient-Centered Care for Older Adults with Multiple Chronic Conditions: A Stepwise Approach from the American Geriatrics Society. Journal of the American Geriatrics Society. 2012,60 (10):1957-68. DOI:10.1111/j. 1532-5415.2012.04187. x
46. Barry PJ, Gallagher P., Ryan C., O’mahony D. START (screening tool to alert doctors to the right treatment) an evidence-based screening tool to detect prescribing omissions in elderly patients. Age and Ageing. 2007,36 (6):632-8. DOI:10.1093/ageing/afm118
47. FORTA, Pazan F., Weiss C., Wehling M. The EURO-FORTA (Fit fOR The Aged) List: International Consensus Validation of a Clinical Tool for Improved Drug Treatment in Older People. Drugs & Aging. 2018,35 (1):61-71. DOI:10.1007/s40266-017-0514-2
48. Boyd CM, Kent D.M. Evidence-Based Medicine and the Hard Problem ofMultimorbidity. Journal of General Internal Medicine. 2014,29 (4):552-3. DOI: 10.1007/s11606-013-2658-z
49. Muche-Borowski C, Lühmann D, Schäfer I, Mundt R, Wagner H-O, Scherer M. Development ofa meta-algorithm for guiding primary care encounters for patients with multimorbidity using evidence-based and case-based guideline development methodology. BMJ Open. 2017,7 (6):e015478.DOI:10.1136/bmjopen-2016-015478
50. Andrews JC, Schünemann HJ, Oxman AD, Pottie K, Meerpohl JJ, Coello PA et al. GRADE guidelines: 15. Going from evidence to recommendation - determinants of a recommendation’s direction and strength. Journal of Clinical Epidemiology. 2013,66 (7):726-35. DOI:10.1016/j.jclinepi. 2013.02.003
51. Schoen C, Osborn R, Squires D, Doty MM, Pierson R, Applebaum S. How Health Insurance Design Affects Access To Care And Costs, By Income, In Eleven Countries. Health Affairs. 2010,29 (12):2323-34.DOI:10.1377/hlthaff. 2010.0862
52. Göhler A, Januzzi JL, Worrell SS, Osterziel KJ, Scott Gazelle G, Dietz R et al. A Systematic Meta-Analysis of the Efficacy and Heterogeneity of Disease Management Programs in Congestive Heart Failure. Journal of Cardiac Failure. 2006,12 (7):554-67. DOI:10.1016/j. cardfail. 2006.03.003
53. Benfante A, Basile M, Battaglia S, Spatafora M, Scichilone N. The use of ICS/LABA (extra-fine and non-extra-fine) in elderly asthmatics. Therapeutics and Clinical Risk Management. 2016, Volume 12:1553-62. DOI:10.2147/TCRM. S103709
54. Paez RA., Zhao L, Hwang W. Rising Out-Of-Pocket Spending For Chronic Conditions: A Ten-Year Trend. Health Affairs. 2009,28 ( 1 ) : 15-25. DOI:10.1377/hlthaff. 28.1.15
55. Wittenberg R. The challenge ofmeasuring multi-morbidity and its costs. IsraelJournal ofHealth PolicyResearch. 2015,4 (1). DOI:10.1186/2045-4015-4-1
56. O’Toole J, Hambly R, Cox A-M, O’Shea B, Darker C. Methadone-maintained patients in primary care have higher rates of chronic disease and multimorbidity, and use health services more intensively than matched controls. EuropeanJournal of General Practice. 2014,20 (4):275-80. DOI:10.3109/13814788.2014.905912
57. Fox MH, Reichard A. Disability, Health, and Multiple Chronic Conditions Among People Eligible for Both Medicare and Medicaid, 2005-2010. Preventing Chronic Disease. 2013,10. DOI:10.5888/pcd10.130064
58. Panagioti M, Richardson G, Murray E, Rogers A, Kennedy A, Newman S et al. Reducing Care Utilisation through Self-management Interventions (RECURSIVE): a systematic review and meta-analysis. Health Services and Delivery Research. 2014,2 (54):1-200. DOI:10.3310/hsdr02540
59. Lehnert T, Heider D, Leicht H, Heinrich S, Corrieri S, Luppa M et al. Review: Health Care Utilization and Costs of Elderly Persons With Multiple Chronic Conditions. Medical Care Research and Review. 2011,68 (4):387-420. DOI:10.1177/1077558711399580
60. Raftery JP, Yao GL, Murchie P, Campbell NC, Ritchie LD. Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: follow up of a randomised controlled trial. BMJ. 2005,330 (7493):707. DOI:10.1136/bmj. 38342.665417.8F
61. Fagan KJ, Zhao EY, Horsfall LU, Ruffin BJ, Kruger MS, McPhail SM et al. Burden of decompensated cirrhosis and ascites on hospital services in a tertiary care facility: time for change?: Burden of cirrhosis and ascites. Internal Medicine Journal. 2014,44 (9):865-72. DOI:10.1111/imj. 12491
62. Price E, Baker R, KrauseJ, Keen C. Organisation of services for people with cardiovascular disorders in primary care: transfer to primary care or to specialist-generalist multidisciplinary teams? BMC Family Practice. 2014, 15(1). DOI:10.1186/1471-2296-15-158