Polypharmacy in Older Adults Hospitalized for Heart Failure
Key result
Polypharmacy involving ten or more medications affects ~55% of older HF patients at hospital discharge.
- n=558
Why the study?
Despite potential harm from polypharmacy, real-world data on polypharmacy in the setting of heart failure are limited.
What is the prevalence and composition of polypharmacy among older adults hospitalized for heart failure?
Population
558 older adults aged ≥65 years with adjudicated HF hospitalizations from 380 US hospitals
Comparison
Hospital admission vs hospital discharge
Design
Observational study derived from the REGARDS study
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The medication burden for older adults with heart failure was higher following a heart failure hospitalization. Some of these drugs may be appropriate. However, our prior work has shown that many patients are discharged with prescriptions for medications that can worsen heart failure. This supports the ongoing need for improved and routine medication review processes prior to hospital discharge, and particularly in the immediate post-discharge period where the risk of hospital readmission is particularly high.”
“The objective here was to show that almost all heart failure patients contend with polypharmacy, and hopefully generate a greater appreciation of this concept among the various specialties that care for adults with heart failure. These findings support the importance of thinking very carefully about every medication that we're recommending and making sure that the right medications are taken by the right patient at the right time.”
GFGregg FonarowChief of cardiology, UCLA
“That doesn't mean there are not some medications that are not necessary and could be either reduced or consolidated, but that for patients with heart failure that have a number of other comorbid conditions there are a number of medications that are proven in randomized trials, proven in clinical effectiveness studies -- including in patients above age 65 -- to where the greater the number of medications patients are on, the better the clinical outcomes.”
Implication
High polypharmacy burden in hospitalized HF patients warrants medication review; leaves open whether deprescribing improves outcomes.
Key Points
- To investigate the prevalence and implications of polypharmacy in older adults hospitalized for heart failure.
- Examined 558 older adults aged ≥65 years from the REGARDS study with heart failure hospitalizations.
- Classified medications into HF-related, non-HF cardiovascular-related, or noncardiovascular-related categories.
- Collected data from medical charts, hospital admissions, and Medicare's Hospital Compare website.
- 84% of participants were on ≥5 medications at admission, and 95% at discharge; 42% at admission and 55% at discharge took ≥10 medications.
- The prevalence of polypharmacy (≥10 medications) increased over time, with a more rapid rise in noncardiovascular medications compared to HF-related or non-HF cardiovascular medications.
- Defining polypharmacy as taking ≥10 medications may better reflect the needs of the heart failure population.
Study Design
Type
Observational (n=558)
Multicenter
Yes
Structured PICO
What is the prevalence and composition of polypharmacy among older adults hospitalized for heart failure?
P
Population
558 older adults aged ≥65 years with adjudicated heart failure hospitalizations from 380 hospitals across the United States (derived from the REGARDS study).
I
Intervention
Assessment of medication burden (number of medications taken) at hospital admission and discharge.
O
Outcome
Prevalence of polypharmacy (taking ≥5 or ≥10 medications) at hospital admission and discharge, and classification of medications as HF-related, non-HF cardiovascular-related, or noncardiovascular-related.
Polypharmacy is highly prevalent and increasing among older adults hospitalized for heart failure, with the majority of the medication burden consisting of noncardiovascular drugs.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Cite This Study
Ünlü et al. (2020) conducted an observational in Heart Failure (n=558). Polypharmacy was evaluated on Number of medications taken at hospital admission and discharge. Polypharmacy, defined as taking ≥10 medications, was highly prevalent among older adults hospitalized for heart failure, occurring in 42% at admission and 55% at discharge.