Ischemic cardiomyopathy was associated with higher medication regimen complexity compared to nonischemic cardiomyopathy in older adults with heart failure (pMRCI 34.5 vs 28.8, P=0.009).
Observational (n=145)
Does medication regimen complexity differ by age group or heart failure etiology in ambulatory older adults with heart failure?
Medication regimen complexity and polypharmacy are highly prevalent in older adults with heart failure, particularly those with ischemic etiology.
Absolute Event Rate: 34.5% vs 28.8%
p-value: p=0.009
Purpose: Heart failure prevalence is increasing in older adults, and polypharmacy is a major problem in this population. We compared medication regimen complexity using the validated patient-level Medication Regimen Complexity Index (pMRCI) tool in “young-old” (60–74 years) versus “old-old” (75–89 years) patients with heart failure. We also compared pMRCI between patients with ischemic cardiomyopathy (ISCM) versus nonischemic cardiomyopathy (NISCM). Patients and methods: Medication lists were retrospectively abstracted from the electronic medical records of ambulatory patients aged 60–89 years with heart failure. Medications were categorized into three types – heart failure prescription medications, other prescription medications, and over-the-counter (OTC) medications – and scored using the pMRCI tool. Results: The study evaluated 145 patients (n=80 young-old, n=65 old-old, n=85 ISCM, n=60 NISCM, mean age 73±7 years, 64% men, 81% Caucasian). Mean total pMRCI scores (32.1±14.4, range 3–84) and total medication counts (13.3±4.8, range 2–30) were high for the entire cohort, of which 72% of patients were taking eleven or more total medications. Total and subtype pMRCI scores and medication counts did not differ significantly between the young-old and old-old groups, with the exception of OTC medication pMRCI score (6.2±4 young-old versus 7.8±5.8 old-old, P =0.04). With regard to heart failure etiology, total pMRCI scores and medication counts were significantly higher in patients with ISCM versus NISCM (pMRCI score 34.5±15.2 versus 28.8±12.7, P =0.009; medication count 14.1±4.9 versus 12.2±4.5, P =0.008), which was largely driven by other prescription medications. Conclusion: Medication regimen complexity is high in older adults with heart failure, and differs based on heart failure etiology. Additional work is needed to address polypharmacy and to determine if medication regimen complexity influences adherence and clinical outcomes in this population. Keywords: medication complexity, heart failure, elderly, geriatric, aged
Cobretti et al. (Sat,) conducted a observational in Heart failure (n=145). Ischemic cardiomyopathy vs. Nonischemic cardiomyopathy was evaluated on Total patient-level Medication Regimen Complexity Index (pMRCI) score (p=0.009). Ischemic cardiomyopathy was associated with higher medication regimen complexity compared to nonischemic cardiomyopathy in older adults with heart failure (pMRCI 34.5 vs 28.8, P=0.009).