Is new care strategy required for survivors of critical illnesses with multimorbidity?

Recently published study reviewed the impact of multimorbidity on the recovery trajectories and outcomes of critical illness survivors, aiming to identify factors that predispose such survivors to worse outcomes and explore potential strategies to enhance their long-term recovery.

Influence of Multimorbidity on Critical Illness Outcomes

The study notes that previous research efforts have largely focused on rehabilitation interventions to address physical, psychological, and cognitive functional sequelae after critical illness. However, recent evidence suggests that a person’s existing health status, particularly multimorbidity and frailty, strongly influences long-term outcomes. The review examines the complex relationship between multimorbidity and patient outcomes after critical illness, highlighting the multitude of factors, including the number, severity, and modifiability of medical conditions, treatment burden, functional status, healthcare delivery, and social support, that mediate these relationships.

Factors Mediating the Relationship

Critical illness survivors with multimorbidity, defined as the coexistence of at least two chronic conditions, experience significantly worse recovery trajectories and outcomes compared to previously healthy patients. The review proposes that the impact of the acute illness on survivors with multimorbidity may be overwhelmed by pre-illness factors, leading to worse outcomes. Several factors play a role in mediating the relationship between multimorbidity and outcomes, including biological and pathophysiological mechanisms, specific conditions and multimorbidity clusters, functional impairment and frailty, social context, treatment burden, and healthcare context. The review also explores the potential mechanisms by which critical illness may drive biological aging and exacerbate existing conditions.

To improve outcomes for critical illness survivors with multimorbidity, the review suggests several potential strategies, such as personalized care, shared decision making, identification and optimization of multimorbidity and related factors, and management of treatment burden and self-management support. The proposed care pathways for these patients would need to consider individual patient priorities and preferences, address fragility and social circumstances, and include a multifaceted approach to optimize care. The review recommends enhanced identification and optimization of multimorbidity and related factors, provision of personalized care based on patient priorities and preferences, and orientation towards family and informal carer support.

Recommendations for Enhanced Care

The study proposes the need to enhance care for critical illness survivors with multimorbidity by considering their pre-existing health status and personal factors. It highlights the importance of addressing treatment burden, self-management support, family and informal carer orientation, health and social care context, and the potential benefits of digital health solutions in supporting self-management for these patients. The review concludes by noting that despite the numerous unanswered questions, the identification of multimorbidity and related factors is crucial in developing an optimal model of care for these individuals.

Reference-

Stewart, J., Bradley, J., Smith, S. et al. Do critical illness survivors with multimorbidity need a different model of care?. Crit Care 27, 485 (2023). https://doi.org/10.1186/s13054-023-04770-6.