Heart failure, comorbidities, and polypharmacy among elderly nursing home residents

Abstract

Introduction: Heart failure (HF) in the elderly is frequently associated with limited therapeutic options and may cause severe complications. Unfortunately, these patients are often excluded from clinical trials.

Objectives: The aim of the study was to determine the relationship between HF, coexisting diseases, and use of medications in patients of advanced age living in nursing homes.

Patients and methods: The study group included 79 women and 21 men between 65 and 102 years of age living in 2 nursing homes. Information about the health status of patients was gathered from history and medical records. We conducted a physical examination and, in eligible cases, also an orthostatic test. Comorbidity was assessed using the age‑adjusted Charlson comorbidity index (ACCI).

Results: The prevalence of HF was 26%. The number of chronic diseases coexisting with HF was remarkably higher than the number of diseases among patients without HF (median, 6 [0-11] vs. 3 [0-8]; P <0.0001). The ACCI was also higher in the HF group compared with patients without HF (median, 7 [5-12] vs. 5.5 [2-9]; P <0.0001). Patients with HF took significantly more medications, although HF was treated according to the current guidelines in less than half of the cases.

Conclusions: Our data revealed that HF is associated with significant morbidity and polypharmacy. There is a need for further research that would guide therapy of HF in elderly patients with limited life expectancy and multiple comorbidities as inhabitants of nursing homes. Nonetheless, the current treatment of nursing home patients with HF seems to be suboptimal.