PurposeHeart failure prevalence is increasing in older adults, and polypharmacy is a major problem in this population. We compared medication regimen complexity using the validated patient-level Medication Regimen Complexity Index (pMRCI) tool in “young-old” (60–74 years) versus “old-old” (75–89 years) patients with heart failure. We also compared pMRCI between patients with ischemic cardiomyopathy (ISCM) versus nonischemic cardiomyopathy (NISCM).Patients and methodsMedication lists were retrospectively abstracted from the electronic medical records of ambulatory patients aged 60–89 years with heart failure. Medications were categorized into three types – heart failure prescription medications, other prescription medications, and over-the-counter (OTC) medications – and scored using the pMRCI tool.ResultsThe study evaluated 145 patients (n=80 young-old, n=65 old-old, n=85 ISCM, n=60 NISCM, mean age 73±7 years, 64% men, 81% Caucasian). Mean total pMRCI scores (32.1±14.4, range 3–84) and total medication counts (13.3±4.8, range 2–30) were high for the entire cohort, of which 72% of patients were taking eleven or more total medications. Total and subtype pMRCI scores and medication counts did not differ significantly between the young-old and old-old groups, with the exception of OTC medication pMRCI score (6.2±4 young-old versus 7.8±5.8 old-old, P=0.04). With regard to heart failure etiology, total pMRCI scores and medication counts were significantly higher in patients with ISCM versus NISCM (pMRCI score 34.5±15.2 versus 28.8±12.7, P=0.009; medication count 14.1±4.9 versus 12.2±4.5, P=0.008), which was largely driven by other prescription medications.ConclusionMedication regimen complexity is high in older adults with heart failure, and differs based on heart failure etiology. Additional work is needed to address polypharmacy and to determine if medication regimen complexity influences adherence and clinical outcomes in this population.

Patients in the veteran population with T2DM treated with DPP-4 inhibitors did not demonstrate a significant increase in risk for heart failure exacerbation, regardless of whether a patient had been previously diagnosed with heart failure. This finding potentially supports safe usage of DPP-4 inhibitors in this patient population regardless of heart failure diagnosis.

While amphotericin (AMB) remains the drug of choice for many severe invasive fungal infections, its clinical use is limited by nephrotoxicity. Renal dysfunction is of particular concern in lung transplant recipients (LTR) due to the necessity of other nephrotoxic agents, particularly calcineurin inhibitors (CNI). Pentoxifylline (PTX) may prevent AMB-mediated renal artery vasoconstriction by augmenting production of vasodilatory prostaglandins with consequent suppression of vascular congestion. Despite initial literature that PTX reverses AMB mediated acute renal dysfunction in patients receiving cyclosporine, subsequent supporting data are lacking. This study evaluated the role of PTX in mitigating nephrotoxicity associated with lipid formulations of AMB (L-AMB) in LTR on concomitant CNI. Methods: We performed a single center, retrospective cohort study comparing nephrotoxicity (by RIFLE criteria) in LTR who received intravenous LAMB with or without PTX between 1/2000 and 6/2015. The study excluded LTR on dialysis prior to LAMB initiation. As per the RIFLE criteria, Risk, Injury or Failure following LAMB initiation consisted of a 1.5-fold, 2-fold or 3-fold or greater increase in serum creatinine (SCr) and a 25%, 50% or 75% or greater decrease in GFR. LTR could be categorized in multiple RIFLE groups (not mutually exclusive). Statistical analyses were performed using SPSS. Results: Seventeen LTR received LAMB during the study period. We excluded 3 LTR on dialysis prior to LAMB , leaving 9 LAMB alone and 5 LAMB plus PTX. The groups had similar age, baseline SCr, use of concomitant nephrotoxins, CNI levels and daily LAMB dosing. PTX use was associated with a decreased incidence of nephrotoxicity reaching the Injury threshold despite receiving a longer duration of LAMB therapy and higher cumulative doses. Conclusion: In this study of CNI treated LTR, use of PTX in combination with LAMB was associated with a lower incidence and severity of nephrotoxicity as compared to LAMB alone. Further study is warranted.