Polypharmacy in Heart Failure Patients

Mastromarino, Vittoria; Casenghi, Matteo; Testa, Marco; Gabriele, Erica; Coluccia, Roberta; Rubattu, Speranza; Volpe, Massimo

doi:10.1007/s11897-014-0186-8

Cited by 76 publications

(74 citation statements)

References 68 publications

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“…We found that a higher number of comorbid conditions plus more medications taken daily or polypharmacy, conventionally defined as the chronic use of five or more medications,31 predicted poor medication adherence. These results are consistent with those of others who have found that more comorbid conditions and more pills taken each day predicted poor medication adherence 32.…”

Section: Discussionmentioning

confidence: 87%

What puts heart failure patients at risk for poor medication adherence?

Knafl¹,

Riegel²

2014

PPA

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BackgroundMedication nonadherence is a major cause of hospitalization in patients with heart failure (HF), which contributes enormously to health care costs. We previously found, using the World Health Organization adherence dimensions, that condition and patient level factors predicted nonadherence in HF. In this study, we assessed a wider variety of condition and patient factors and interactions to improve our ability to identify those at risk for hospitalization.Materials and methodsMedication adherence was measured electronically over the course of 6 months, using the Medication Event Monitoring System (MEMS). A total of 242 HF patients completed the study, and usable MEMS data were available for 218 (90.1%). Participants were primarily white (68.3%), male (64.2%), and retired (44.5%). Education ranged from 8–29 years (mean, 14.0 years; standard deviation, 2.9 years). Ages ranged from 30–89 years (mean, 62.8 years; standard deviation, 11.6 years). Analyses used adaptive methods based on heuristic searches controlled by cross-validation scores. First, individual patient adherence patterns over time were used to categorize patients in poor versus better adherence types. Then, risk factors for poor adherence were identified. Finally, an effective model for predicting poor adherence was identified based on identified risk factors and possible pairwise interactions between them.ResultsA total of 63 (28.9%) patients had poor adherence. Three interaction risk factors for poor adherence were identified: a higher number of comorbid conditions with a higher total number of daily medicines, older age with poorer global sleep quality, and fewer months since diagnosis of HF with poorer global sleep quality. Patients had between zero and three risk factors. The odds for poor adherence increased by 2.6 times with a unit increase in the number of risk factors (odds ratio, 2.62; 95% confidence interval, 1.78–3.86; P<0.001).ConclusionNewly diagnosed, older HF patients with comorbid conditions, polypharmacy, and poor sleep are at risk for poor medication adherence. Interventions addressing these specific barriers are needed.

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Section: Discussionmentioning

confidence: 87%

What puts heart failure patients at risk for poor medication adherence?

Knafl¹,

Riegel²

2014

PPA

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“…Comorbidity is extremely common in patients with HF (Braunstein et al, 2003) and adds complexity to the medication regimen required of patients, in part due to the number of medications, drug interactions, and side effects (Mastromarino et al, 2014). Multiple chronic conditions have been shown to complicate self-care when patient care is fragmented (Dickson, Buck, & Riegel, 2011).…”

Section: Discussionmentioning

confidence: 99%

Predictors of medication nonadherence differ among black and white patients with heart failure

2015

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Heart failure (HF) is a global public health problem, and outcomes remain poor, especially among ethnic minority populations. Medication adherence can improve heart failure outcomes but is notoriously low. The purpose of this secondary analysis of data from a prospective cohort comparison study of adults with heart failure was to explore differences in predictors of medication nonadherence by racial group (Black vs. White) in 212 adults with heart failure. Adaptive modeling analytic methods were used to model HF patient medication nonadherence separately for Black (31.7%) and White (68.3%) participants in order to investigate differences between these two racial groups. Of the 63 Black participants, 33.3% had low medication adherence, compared to 27.5% of the 149 White participants. Among Blacks, 16 risk factors were related to adherence in bivariate analyses; four of these (more comorbidities, lower serum sodium, higher systolic blood pressure, and use of fewer activities compensating for forgetfulness) jointly predicted nonadherence. In the multiple risk factor model, the number of risk factors in Black patients ranged from 0 to 4, and 76.2% had at least one risk factor. The estimated odds ratio for medication nonadherence was increased 9.34 times with each additional risk factor. Among White participants, five risk factors were related to adherence in bivariate analyses; one of these (older age) explained the individual effects of the other four. Because Blacks with HF have different and more risk factors than Whites for low medication adherence, interventions are needed that address unique risk factors among Black patients with HF.

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“…Publications involving elderly clients, who are more likely to have associated comorbidities and polypharmacy, report that the risk of adverse reactions increases from 13% for two drugs to 82% when taking more than seven drugs to 100% when using more than 10 drugs [58]. Specifically, for beta-blockers, the COPERNICUS study with carvedilol reported drug-related adverse events in 3-5% (mainly bradycardia, hypotension and syncope) with similar findings from the SENIORS study in older CHF clients, with reported rates of 4-17% for these symptoms.…”

Section: Box 5 Search Differentials Using Common Abstractmentioning

confidence: 99%

Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines

Iyngkaran

Kangaharan²,

Zimmet³

et al. 2016

CCR

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Chronic heart failure (CHF) among Aboriginal/Indigenous Australians is endemic. There are also grave concerns for outcomes once acquired. This point is compounded by a lack of prospective and objective studies to plan care. To capture the essence of the presented topic it is essential to broadly understand Indigenous health. Key words such as ‘worsening’, ‘gaps’, ‘need to do more’, ‘poorly studied’, or ‘future studies should inform’ occur frequently in contrast to CHF research for almost all other groups. This narrative styled opinion piece attempts to discuss future directions for CHF care for Indigenous Australians. We provide a synopsis of the problem, highlight the treatment gaps, and define the impediments that present hurdles in optimising CHF care for Indigenous Australians.

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Polypharmacy in Heart Failure Patients

Cited by 76 publications

References 68 publications

What puts heart failure patients at risk for poor medication adherence?

What puts heart failure patients at risk for poor medication adherence?

Predictors of medication nonadherence differ among black and white patients with heart failure

Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines

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