| Summary: | Henrik Toft Sørensen,1 Lars Pedersen,1 Jørgen Jørgensen,2 Vera Ehrenstein11Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, 2Danish Regions, Copenhagen, DenmarkThe health care systems in many countries are facing several challenges: the aging population,the need for personalized medicine, evolving treatment modalities, quality andsafety imperatives, and unsustainable costs, to mention only a few. Population aging in the face of significant pressure to contain costs is perhaps the most immediate challenge. The proportion of people aged 65 years or older in Western Europe and North America is expected to increase to 26% in 2025. Furthermore, clinical medicine in the Western world is confronting an evolving set of diseases, as smoking becomes less prevalent and obesity more common. Diagnostics and treatment of chronic disease have improved, while the threshold for initiating preventive treatment of asymptomatic conditions has been lowered. Consequently, the number of patients with multimorbidity, that is, the coexistence of several chronic diseases, will increase dramatically.1 To treat a disease or prevent its progression, patients with several chronic diseases often take multiple drugs, each with potentially severe side effects. In patients with multiple morbidities, “polypharmacy” is a challenging clinical issue, often associated with iatrogenic harm.2 A call for innovative approaches to polypharmacy has been the focus of recent editorials in high-impact medical journals.3–5 Randomized trials rarely address multimorbidity, adherence to treatments, co-intervention (polypharmacy), or their long-term risks.6 These challenges underscore the need for population-based long-term longitudinal clinical data available for clinical care and research.
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