2022 ACC Expert Consensus Decision Pathway for Integrating Atherosclerotic Cardiovascular Disease and Multimorbidity Treatment: A Framework for Pragmatic, Patient-Centered Care

Atherosclerotic cardiovascular disease (ASCVD) is one of the most common chronic medical conditions worldwide. Most patients with ASCVD have other chronic conditions. Fractionated care plans, polypharmacy, side effects, drug-drug interactions, and financial toxicity can all begin to accumulate as patients acquire multimorbidity and advancing age. Clinicians caring for these patients need better guidance on how to mitigate ASCVD pro-gression and major adverse cardiovascular events within the context of other chronic conditions, multiple guideline-directed medical therapies, changing progno-ses, and patient preferences for care. Although this deci-sion pathway is applicable to patients of all ages with ASCVD and multimorbidity, herein we advocate for the integration of evidence-based treatments into a broader value-based care framework that incorporates the Amer-ican Geriatrics Society's principles on the care of older adults with multimorbidity, the 4Ms from the Age -Friendly Health System, the 4-domain framework of care for older adults with heart failure, and social de-terminants of health. As patients acquire more chronic conditions, the burdens of available therapy intensify while life expectancy shortens. Accordingly, care for pa-tients must shift from recommending all evidence-based options to an approach that prioritizes therapies with the greatest expected benefit/harm profile, while aligning with patients' goals and preferences.