Polypharmacy in Heart Failure with Reduced Ejection Fraction: Progress, Not Problem

Rao, Vishal N.; Fudim, Marat; Savarese, Gianluigi; Butler, Javed

doi:10.1016/j.amjmed.2021.03.038

Cited by 19 publications

(7 citation statements)

References 13 publications

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“…A pharmacist is an important element of the multidisciplinary team, and several studies have demonstrated the effectiveness of such an approach to improve the overall quality of medication prescribing in older adults [298].…”

Section: Genetic Counsellingmentioning

confidence: 99%

World Heart Federation Consensus on Transthyretin Amyloidosis Cardiomyopathy (ATTR-CM)

Brito,

Albrecht,

de Arenaza

et al. 2023

Global Heart

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Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive and fatal condition that requires early diagnosis, management, and specific treatment. The availability of new disease-modifying therapies has made successful treatment a reality. Transthyretin amyloid cardiomyopathy can be either age-related (wild-type form) or caused by mutations in the TTR gene (genetic, hereditary forms). It is a systemic disease, and while the genetic forms may exhibit a variety of symptoms, a predominant cardiac phenotype is often present. This document aims to provide an overview of ATTR-CM amyloidosis focusing on cardiac involvement, which is the most critical factor for prognosis. It will discuss the available tools for early diagnosis and patient management, given that specific treatments are more effective in the early stages of the disease, and will highlight the importance of a multidisciplinary approach and of specialized amyloidosis centres.To accomplish these goals, the World Heart Federation assembled a panel of 18 expert clinicians specialized in TTR amyloidosis from 13 countries, along with a representative from the Amyloidosis Alliance, a patient advocacy group. This document is based on a review of published literature, expert opinions, registries data, patients' perspectives, treatment options, and ongoing developments, as well as the progress made possible via the existence of centres of excellence.From the patients' perspective, increasing disease awareness is crucial to achieving an early and accurate diagnosis. Patients also seek to receive care at specialized amyloidosis centres and be fully informed about their treatment and prognosis.

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Section: Genetic Counsellingmentioning

confidence: 99%

World Heart Federation Consensus on Transthyretin Amyloidosis Cardiomyopathy (ATTR-CM)

Brito,

Albrecht,

de Arenaza

et al. 2023

Global Heart

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“…Other adverse effects of polypharmacy include higher rates of malnutrition, increased urinary incontinence, which is more common in women over 70 years-of-age, increased risk of cognitive impairment (especially delirium) and a reduced ability to perform activities of daily living ( 44 ). These reports emphasize the importance of a multidisciplinary approach to the care of older adults to combat this risk, including a pharmacist and elder care specialist ( 48 ). Previous studies have demonstrated the effectiveness of a multidisciplinary approach to improve the overall quality of medication prescribing in older adults ( 44 ).…”

Section: Care Considerations Of Older Attr-cm Patientsmentioning

confidence: 99%

Assessment and Management of Older Patients With Transthyretin Amyloidosis Cardiomyopathy: Geriatric Cardiology, Frailty Assessment and Beyond

Irabor

McMillan

Fine

2022

Front. Cardiovasc. Med.

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Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is commonly diagnosed in older adults, in particular the wild-type (ATTRwt), which is regarded as an age-related disease. With an aging population and improved diagnostic techniques, the prevalence and incidence of ATTR-CM will continue to increase. With increased availability of mortality reducing ATTR-CM therapies, patients are living longer. The predominant clinical manifestation of ATTR-CM is heart failure, while other cardiovascular manifestations include arrhythmia and aortic stenosis. Given their older age at diagnosis, patients often present with multiple age-related comorbidities, some of which can be exacerbated by ATTR, including neurologic, musculoskeletal, and gastrointestinal problems. Considerations related to older patient care, such as frailty, cognitive decline, polypharmacy, falls/mobility, functional capacity, caregiver support, living environment, quality of life and establishing goals of care are particularly important for many patients with ATTR-CM. Furthermore, the high cost ATTR treatments has increased interest in establishing improved predictors of response to therapy, with assessment of frailty emerging as a potentially important determinant. Multidisciplinary care inclusive of collaboration with geriatric and elder care medicine specialists, and others such as neurology, orthopedic surgery, electrophysiology and transcatheter aortic valve replacement clinics, is now an important component of ATTR-CM management. This review will examine current aspects of the management of older ATTR-CM patients, including shared care with multiple medical specialists, the emerging importance of frailty assessment and other considerations for using ATTR therapies.

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“…This perspective discourages the prescription of additional potentially beneficial treatments in such individuals. [8][9][10][11][12] Inappropriate prescribing may even lead to patients receiving harmful drugs. 13 However, in a recent analysis of the DELIVER trial ( Fraction Heart Failure), the relative reduction in the risk of the primary endpoint with sodium-glucose cotransporter 2 inhibitor treatment was at least as large in patients with polypharmacy as in those without; indeed, there was a trend to a greater reduction in patients taking a larger number of medications (p = 0.06 for interaction between number of drugs and effect of dapagliflozin).…”

Section: Introductionmentioning

confidence: 99%

“…These concerns often lead to the belief that new therapies will be less effective in older comorbid patients receiving multiple other drugs. This perspective discourages the prescription of additional potentially beneficial treatments in such individuals 8–12 . Inappropriate prescribing may even lead to patients receiving harmful drugs 13 .…”

Section: Introductionmentioning

confidence: 99%

Effects of sacubitril/valsartan according to polypharmacy status in PARAGON‐HF

Matsumoto,

Yang,

Shen

et al. 2024

European J of Heart Fail

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AimsPatients with heart failure (HF) and preserved ejection fraction (HFpEF) have a particularly high prevalence of comorbidities, often necessitating treatment with many medications. The aim of this study was to evaluate the association between polypharmacy status and outcomes in PARAGON‐HF.Methods and resultsIn this post hoc analysis, baseline medication status was available in 4793 of 4796 patients included in the primary analysis of PARAGON‐HF. The effects of sacubitril/valsartan, compared with valsartan, were assessed according to the number of medications at baseline: 683 non‐polypharmacy (<5 medications); 2750 polypharmacy (5–9 medications), and 1360 hyper‐polypharmacy (≥10 medications). The primary outcome was total HF hospitalizations and cardiovascular deaths. Patients with hyper‐polypharmacy were older, had more severe limitations due to HF (worse New York Heart Association class and Kansas City Cardiomyopathy Questionnaire scores), and had greater comorbidity. The non‐adjusted risk of the primary outcome was significantly higher in patients taking more medications, and similar trends were seen for HF hospitalization and cardiovascular and all‐cause death. The effect of sacubitril/valsartan versus valsartan on the primary outcome from the lowest to highest polypharmacy category was (as a rate ratio): 1.19 (0.76–1.85), 0.94 (0.77–1.15), and 0.77 (0.61–0.96) (pinteraction = 0.16). Treatment‐related adverse events were more common in patients in the higher polypharmacy categories but not more common with sacubitril/valsartan, versus valsartan, in any polypharmacy category.ConclusionsPolypharmacy is very common in patients with HFpEF, and those with polypharmacy have worse clinical status and a higher rate of non‐fatal and fatal outcomes. The benefit of sacubitril/valsartan was not diminished in patients taking a larger number of medications at baseline.

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Polypharmacy in Heart Failure with Reduced Ejection Fraction: Progress, Not Problem

Cited by 19 publications

References 13 publications

World Heart Federation Consensus on Transthyretin Amyloidosis Cardiomyopathy (ATTR-CM)

World Heart Federation Consensus on Transthyretin Amyloidosis Cardiomyopathy (ATTR-CM)

Assessment and Management of Older Patients With Transthyretin Amyloidosis Cardiomyopathy: Geriatric Cardiology, Frailty Assessment and Beyond

Effects of sacubitril/valsartan according to polypharmacy status in PARAGON‐HF

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