Ten or extra medicines, usually prescribed to older coronary heart failure sufferers, raises issues

More than half of elderly patients hospitalized for heart failure, a progressive disease in which the heart does not pump as well as it should, will end up with prescriptions for 10 or more drugs, according to new research published today in Circulation discharged from hospital: Heart Failure, an American Heart Association magazine.

“High drug exposure, also known as polypharmacy, is often associated with adverse events and reactions,” said Dr. med. Parag Goyal, lead study author and assistant professor of medicine at Weill Cornell Medicine and geriatric cardiologist in New York. Presbyterian / Weill Cornell Medical Center in New York City. “As treatment options for a variety of conditions, including heart failure, increase and the population ages, it becomes increasingly important to weigh the risks and potential benefits of multiple drugs.”

To study the drug exposure of older adults with heart failure, the researchers examined the medical charts of 558 adults aged 65 and over who were covered by Medicare and hospitalized for heart failure in one of 380 hospitals in the US between 2003 and 2014 The Reasons for Geographical and Racial Differences in Stroke (REGARDS), a large nationwide prospective observational cohort of over 30,000 participants that began in 2003 and continues with ongoing follow-up.

For this analysis, the number of medications for each patient on admission and discharge to hospital was determined. Medicines have been categorized according to the primary condition they treat: heart failure; other types of heart disease (such as aspirin and statin for coronary heart disease); or not heart-related (such as drugs for lung, kidney or type 2 diabetes).

Researchers found:

On admission to hospital, 84% of study participants took five or more drugs and 42% took 10 or more.

Participants were discharged from hospital with prescriptions for more drugs than when they were admitted: 95% were prescribed five or more drugs; and 55% were prescribed 10 or more on discharge from the hospital.

Polypharmacy has become more common. 41% of participants who were hospitalized between 2003 and 2006, and 10% of patients who were hospitalized between 2011 and 2014, prescribed 10 or more drugs on discharge.

Most of the medications taken by participants with heart failure did not address the treatment of heart failure or heart disease.

“The drug burden for older adults with heart failure was higher after hospitalization with heart failure. Some of these drugs may be appropriate. However, our previous work has shown that many patients are discharged with prescriptions for drugs that can make heart failure worse. This supports the persistence Need for improved and routine drug review processes before hospital discharge, and especially in the immediate post-discharge period, when the risk of hospital readmission is particularly high, “said Goyal, who also runs the Conserved Ejection Fraction Heart Failure Program directs Weill Cornell Medicine and at the New York Presbyterian / Weill Cornell Medical Center.

According to researchers, this study was done before several new heart failure drugs were approved, so the number of people with heart failure who were prescribed 10 or more drugs may be even higher today.

“Advances in medicine have offered patients an increasing number of treatment options. This is a good thing. However, it is also important to consider the negative consequences of more drugs being prescribed for each patient,” Goyal said.

While all adults with heart failure can experience adverse effects from their medications, the researchers suggest that people with heart failure who take 10 or more medications may be particularly susceptible to adverse drug interactions due to possible drug use.

“Our results support the need to tailor drug prescribing decisions for each patient, taking into account their overall health,” said Goyal – when the potential benefits outweigh the risks – start or resume and when the risks outweigh the potential benefits , these drugs are discontinued. “

The researchers found that because their study focused on older adults with Medicare coverage, these results may not be generalizable to younger adults or those who are not enrolled / eligible for Medicare or who do not have health insurance.

For Older Adults With Heart Failure: Can Taking Too Much Medication Affect Your Ability To Perform Daily Activities?

More information:
Ozan Unlu et al., Polypharmacy in Older Adults Hospitalized for Heart Failure, Circulation: Heart Failure (2020). DOI: 10.1161 / CIRCHEARTFAILURE.120.006977 Provided by the American Heart Association

Quote: Ten or more medications often prescribed to elderly heart failure patients are a cause for concern (2020, October 13), posted on October 13, 2020 at https://medicalxpress.com/news/2020-10-ten- medications-older-heart-failure .html

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