Polypharmacy in Older Adults Hospitalized for Heart Failure

Abstract

Background: Despite potential harm that can result from polypharmacy, real-world data on polypharmacy in the setting of heart failure (HF) are limited. We sought to address this knowledge gap by studying older adults hospitalized for HF derived from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Methods: We examined 558 older adults aged ≥65 years with adjudicated HF hospitalizations from 380 hospitals across the United States. We collected and examined data from the REGARDS baseline assessment, medical charts from HF-adjudicated hospitalizations, the American Hospital Association annual survey database, and Medicare’s Hospital Compare website. We counted the number of medications taken at hospital admission and discharge; and classified each medication as HF-related, non-HF cardiovascular-related, or noncardiovascular-related. Results: The vast majority of participants (84% at admission and 95% at discharge) took ≥5 medications; and 42% at admission and 55% at discharge took ≥10 medications. The prevalence of taking ≥10 medications (polypharmacy) increased over the study period. As the number of total medications increased, the number of noncardiovascular medications increased more rapidly than the number of HF-related or non-HF cardiovascular medications. Conclusions: Defining polypharmacy as taking ≥10 medications might be more ideal in the HF population as most patients already take ≥5 medications. Polypharmacy is common both at admission and hospital discharge, and its prevalence is rising over time. The majority of medications taken by older adults with HF are noncardiovascular medications. There is a need to develop strategies that can mitigate the negative effects of polypharmacy among older adults with HF.

Polypharmacy definition and prevalence in heart failure: a systematic review

“…The included studies were all observational in nature and consisted of 7 (41.2%) cohort studies [12][13][14][15][16][17][18], 13 (58.8%) cross-sectional studies [19][20][21][22][23][24][25][26][27][28][29][30][31], and 2 studies were secondary analyses from previous randomized controlled trial datasets [32,33]. In total, 70,695 heart failure patients were included in the studies.…”

“…Studies were across a range of care settings: 8 from outpatients clinics [12,13,22,23,30,[32][33][34], 11 from hospital inpatients [14-18, 25-29, 31] and 1 from each general population [21], nursing homes [24] and primary care [19]. Studies were from across the globe: 7 from USA [12,21,22,30,31,33,34]; 3 from Italy [16,18,27]; 2 from the UK [14,19], Japan [25,29] and Australia [13,26]; 1 each from of Spain [23], Poland [24], Ethiopia [15], Greece [17] and Slovakia [28] and 1 from north and south America combined [32].…”

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

“…9 Patients with HF often have other comorbidities, and the number of prescribed medications increases with age, yet use of guideline-directed medical therapies remains low in the elderly population. 10 Most older patients hospitalized with heart failure are prescribed greater than 10 medications at discharge and this rate has increased from 41% in 2003-2006 to 68% in 2011-2014. 10 Polypharmacy is generally described as taking at least 5 medications, and it has several downsides including increased risk for drug-interactions, risk for adverse events, difficulties with adherence, and costs.…”

“…10 Most older patients hospitalized with heart failure are prescribed greater than 10 medications at discharge and this rate has increased from 41% in 2003-2006 to 68% in 2011-2014. 10 Polypharmacy is generally described as taking at least 5 medications, and it has several downsides including increased risk for drug-interactions, risk for adverse events, difficulties with adherence, and costs. 11 With increasing availability of evidence-based options for HFrEF treatment, there is a perceived risk for increasing rates of adverse events, especially among older patients.…”

Polypharmacy in Heart Failure: Progress But Also Problem

“…We believe that the increasing attention on polypharmacy and its implications among patients with heart failure 2 is a positive development. To provide holistic goal-concordant patient-centered care, it is essential to integrate concepts that have traditionally been recognized in geriatric medicine into the care of patients with heart failure, the majority of whom are older adults.…”