Polypharmacy Common in Older Patients Hospitalized for Heart Failure

A large majority of older patients hospitalized for heart failure (HF) were found to take ≥10 medications, according to a study published in Circulation Heart Failure.

In this study, researchers examined data from adjudicated HF hospitalizations of 558 Medicare beneficiaries ages ≥65 years (median age, 76.0 years). Hospitalizations occurred across 380 hospitals in the United States between 2003 and 2014. The number of medications taken by patients at time of hospital admission and discharge were obtained from baseline assessment of participants in the Reasons for Geographic and Racial Differences in Stroke study, as well as from medical charts of HF-adjudicated hospitalization, the American Hospital Association annual survey database, and Medicare’s Hospital Compare website.

Each medication was classified as HF-related, non-HF cardiovascular-related, or noncardiovascular-related. Polypharmacy was defined as receipt of ≥10 medications.

In this cohort, 84% and 95% of patients were taking ≥5 medications at time of admission and discharge, respectively. A total of 42% and 55% of patients were taking ≥10 medications at admission and discharge, respectively. Patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) followed a similar pattern in the number of medications taken at admission and discharge.

The prevalence of polypharmacy between hospital admission and discharge increased from 42% to 55% (P <.001). Polypharmacy at hospital admission increased from 25% between 2003 and 2006 to 55% between 2011 and 2014 (P <.0001). Polypharmacy at discharge increased from 41% between 2003 and 2006 to 68% between 2011 and 2014 (P <.0001). Similar trends were observed in patients with HFrEF and HFpEF.

The median number of all medications increased from 9.0 at admission to 10.0 at discharge (P <.0001). The median number of HF medications increased from 2 at admission to 2.5 at discharge (P <.0001), and the median number of non-HF cardiovascular and noncardiovascular medications increased from 2 and 4, respectively at admission to 3 and 4.5, respectively at discharge (P <.0001).

Each additional comorbidity increased the risk for polypharmacy at hospital discharge by 13% (relative risk, 1.13 per comorbid condition; 95% CI, 1.08–1.19; P <.0001).

Limitations of this study include its observational design as well as the sole inclusion older patients with Medicare.

 “Issues like therapeutic competition, defined as the clinical situation where a medication that treats one condition is harmful for another condition, and competing health priorities further complicate optimizing medication regimens in older adults with HF and 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,” noted the study authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Unlu O, Levitan EB, Reshetnyak E, et al. Polypharmacy in older adults hospitalized for heart failure. Published online October 13, 2020. Circ Heart Fail. doi:10.1161/CIRCHEARTFAILURE.120.006977