Table 2.

Typology of comorbid chronic conditions^a

Clinically dominant conditions

Comorbid chronic conditions that are so complex or so serious that they eclipse the management of other health problems. Examples: End-stage diseases: metastatic cancer, New York Heart Association Class 4 heart failure, advanced dementia, chronic obstructive pulmonary disease with severe hypoxia, severe decompensated liver disease, renal failure Severe acute symptoms: chest pain, profound vomiting, unintentional weight loss (>5% body weight) New serious diagnoses: cancer, pulmonary embolism, cerebrovascular accident

Symptomatic versus asymptomatic chronic conditions

Treatment for symptomatic chronic conditions focuses on improving patients' symptom profiles, functioning and quality of life, and may also delay or prevent poor long-term outcomes. Examples: chronic pain, depression, incontinence, falls/fear of falling, functional disability Treatment of asymptomatic chronic conditions focuses almost exclusively on preventing downstream adverse events and early mortality. Examples: hyperlipidemia, mild hypertension

Concordant versus discordant chronic conditions

Concordant conditions represent parts of the same overall pathophysiologic risk profile and are more likely to be the focus of the same disease and self-management plan. Examples: cardiovascular disease, cerebrovascular disease Discordant treatments are not directly related in either their pathogenesis or management. Examples: chronic obstructive pulmonary disease, cancer, anemia

^aAdapted from Piette and Kerr.³⁴