More than half of older patients hospitalized for heart failure are discharged with 10 or more prescriptions, according to research published on October 13, 2020, in the journal Circulation: Heart Failure.
Moreover, researchers found that study participants left the hospital with prescriptions for more medications than they had been on when admitted and that the majority of medications taken by older adults with HF are not for cardiovascular-related conditions.
“High medication burden, also known as polypharmacy is commonly associated with adverse events and reactions,” said senior study author Parag Goyal, MD, MSc, assistant professor of medicine at Weill Cornell Medicine and a geriatric cardiologist at New York-Presbyterian/Weill Cornell Medical Center, in an American Heart Association press release. “As the treatment options for various conditions including heart failure expand and the population ages, it is becoming increasingly important to weigh the risks and possible benefits of multiple medications.”
To explore real world data on polypharmacy among patients with HF, Goyal et al examined the medical charts of 558 adults, aged ≥65 years and older, covered by Medicare and hospitalized for HF between 2003 and 2014 at one of 380 hospitals in the US. All were participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a large nationwide prospective observational cohort of more than 30,000 participants that began in 2003 and continues with ongoing follow-up. Median age of their sample was 76 years, 44% were women, 34% were black.
In this study, polypharmacy was defined as taking ≥10 medications
The number of medications for each participant was recorded at hospital admission and again at discharge. Drugs were classified as HF-related, non-HF cardiovascular-related (eg, aspirin, statins) or non-cardiovascular-related.
RESULTS
At hospital admission
- 84% took ≥5 medications
- 42% took ≥ 10 medications
At hospital discharge, patients left with prescriptions for more
medications than they were taking at admission:
- 95% were prescribed ≥5 medications
- 55% were prescribed ≥10 medications
Polypharmacy is increasingly common. The proportion of participants
hospitalized for HF with ≥10 medications prescribed at discharge was:
- 41% between 2003-2006
- 68% between 2011-2014
Most of the medications taken by participants with heart failure were not to treat heart failure or another cardiovascular condition.
Most common medications initiated between admission and discharge
Loop diuretics 27%
Beta-blockers 21%
Aspirin 19%
Electrolyte supplements 17%
ACE inhibitors 17%
Quinolones 12%
Anticoagulation 12%
PPIs 11%
Statins 11%
P2Y12 inhibitors 10%
Adrenergic bronchodilators 10%
Multivitamins 8%
Nitrates 8%
Antiarrhythmic 8%
MRA 6%
"Our findings support the need to tailor decisions related to medication prescribing for each patient while considering their overall health status,” said Goyal in the AHA statement. “The key to managing polypharmacy is medication review during each appointment.”
The goal, the authors stress, is to initiate or continue medications where potential benefits outweigh risks and to discontinue those found no longer appropriate or for which risks are greater than benefits.
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“Taken together, our findings support the need to develop strategies to mitigate the negative effects of polypharmacy among older adults with HF, potentially starting with formalized processes that can improve prescribing practices for noncardiovascular medications.”
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Limitations of the study include inclusion only of older adults with Medicare coverage thus results may not be generalizable to younger adults or to anyone not receiving healthcare insurance from Medicare or other sources.
